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• WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Department of Public Works
111 H St PO Box 758 Greeley CO 80632
Phone: (970)356-4000 x3750 Fax: (970) 304-6497
Road File#: Date:
RE#: Other Case#:
1. Applicant Nape jpitt/ /" 4 ✓k?t< n,l f Phone 9475--g-9!)-6,-
Address 1 q t- vtl City /rit.e. �*L4 a State a Zip r43
2. Address r Location of Access Cf IAf)rij1G v.k,t
Section j Tow2Js IN -Rage /,./4w Subdivision Block Lot
Weld County Road#: 5 0 Side of Road Distance from nearest intersection ,/a- > •
3. Is there an existing access(es)to the property? Yes No i( #of Accesses
4. Proposed Use:
X' Permanent 33C Residential/Agricultural 0 Industrial
o Temporary( Subdivision 0 Commercial 0 Other
5. Site Sketch:
Legend for Access Description: �'tt�\� it.AG = Agricultural
RES = Residential 1 (Off--V
• O&G = Oil&Gas
D.R. = Ditch Road r 61. - �, l_ oa t� 1
O = House i �`'$'
0 = Shed
A =Proposed Access
♦ = Existing Access
7 IV
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
0 Installation Authorized 0 Information Insufficient
Reviewed By: Title:
• -17-
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