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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 Name BrVkcQ. / Suss Y c m,A\con Phone °I7O S - 1 63C 7
Address I Rti,So w C 2 i i City \ ,.ham 5 ry State Co Zip o,3 H
2. Address or Location of Access
Section Township Range Subdivision Block Lot
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
4. Proposed Use:
❑ Permanent ❑ Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial Other
*
******************************************************************* **********4**;*************************************************
5. Site Sketch `
Legend for Access Description:
AG = Agricultural
C2 t1
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road
r7• = House
= PSroposed Access
• = Existing Access
-15
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***************************************
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-
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