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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: o - k ` - °S
.RE# : Other Case#:
1. Applicant Name Te. 1 Se\l.f0.cte._ Phone 91a - S 3Z - 9'040$
AddressZ3SOS Cow,..k 1 avo4 3 City Love\arc State Co Zip 30537
2. Address or Location of Access g to4' k-kw1. Coo
Section Cv Township 4 M. Range 6'1, u.i . Subdivision Block Lot
Weld County Road#: 5o Side of Road 50u)L Distance from nearest intersection CO -c-�•
3. Is there an existing access(es)to the property? Yes X No #of Accesses _ i
4. Proposed Use:
❑ Permanent ❑ Residential/Agricultural ❑ Industrial
O. Temporary L Subdivision D Commercial ❑ Other r 130
****************************irk**********************************************************************7**************Irk****
5. Site Sketch:
et
J (>k.\-1(.41 GA -J,
a
Legend for Access Description: (*AM CL 5 e [1] I
�
AG = Agricultural II
1
RES = Residential
O&G = Oil&Gas A. �✓
D.R. = Ditch Road 2 5 1-V - f"7 rn
O = House
O = Shed a, u
A = Proposed Access ( Res. 4 o. 4 c,. v 3
= Existing Access (-t•o be. o kaev.acw¢a. 3
—7 ulcer 4$ I
Nfi
•
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:
• V16-
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