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CO 80642 Section 36 Township 2 Range 65 Subdivision N/A Block N/A Lot N/A Weld County Road#: Side of Road Distance from nearest intersection 3. Is there an existing access(es)to the property?Yes X No #of Accesses 3 4. Proposed Use: J Permanent J Residential/Agricultural J Industrial X Temporary J Subdivision U Commercial J Other 5. Site Sketch Legend for Access Description: AG =Agricultural 'N U S RES= Residential �5 ❑ N ,��' O&G=Oil&Gas D.R.=Ditch Road H = House CA S = Shed Ar P= Proposed Access EA= Existing Access RW= Existing Roadway Fj RR= Railroad N OFFICE USE ONLY: Vs) ?_,) g.‘") QQ Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions • J Information Insufficient J Installation Authorized Reviewed By: Title: Hello