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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 Phone
Address p City (} ,�/Statte�� Zip
2. Address or Location of Access 987-7- fit 4 j3 l n ye 11' �O
Section Township Range / Subdivision Block Lot
Weld County Road #: Side of Road Distance from nearest intersection
3. Is there an existing access to the property? Yes K. No #of Accesses
4. Proposed Use:
❑ Permanent ❑ Residential/Agricultural •53f Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
hhhhhhhh***********************************************ltfH*******************************************************************
5. Site Sketch
lie
Legend for Access Description: (�,, G
G = Agricultural f
S = Residential
&G = Oil & Gas 1, § If Y.
DR = Ditch Road
O = House
El = Shed
A = Existing Access a
A = Proposed Access I )_
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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:
-7-
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