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Address or Location of Access Section )-4 Township ! Range .A,4 Subdivision Block Lot Weld County Road #: 13 Side of Road wjEST Distance from nearest intersection 1/2,— RI)L/8 3. Is there an existing access(es) to the property? Yes 'k No #of Accesses 1 4. Proposed Use: Permanent ❑ Residential/Agricultural ❑ Industrial ❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other US ###########*#*#####***#!#*#!*f!****************#******************************!******!********!*****#*f**!************************* 5. Site Sketch Legend for Access Description: I I AG = Agricultural RES = Residential O&G = Oil &Gas D.R. = Ditch Road = House • O = Shed Proposed Access p = Existing Access . Srt J 4 n o � a ce Nfi n **********##*#####*#*#**#!*f#********** OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions ❑ Installation Authorized ❑ Information Insufficient • Reviewed By: Title: -9- Hello