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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 0-661 c 1 'SO l '' 1 / Phone
Address 2° E /(�,Tb T City 6r1Ll<:LE State (.7 Zip .-04,30ro3 f
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2. Address or Location of Access 70 3 /6 , - S 7 ,
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 No #of Accesses
4. Proposed Use:
U Permanent ❑ Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
******************************************t****************************************************************************************
5. Site Sketch
Legend for Access Description: `
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AG = Agricultural
RES = Residential h i
O&G = Oil&Gas rn 1 I
D.R. = Ditch Road : �Q
0 = House •
y;
a = Proposed Access 4
• = Existing Access
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OFFICE USE ONLY; v
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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