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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
lill Phone: (970 )356-4000 x3750 Fax: (970) 304-6497
Road File#: Date:
RE # : Other Case #:
1. Applicant Name reAe, T t-t Phone 303 • 104. 7-5-01-
Address 154.4 w M v '64yv*' Laat City AO4—cls iQa.cl, State lD Zip 96.12.8
2. Address or Location of Access
Section ZS Township I Range AS Subdivision Block Lot
Weld County Road #: 41 Side of Road vice,"- Distance from nearest intersection f1 b(O '
Y
3. Is there an existing access(es)to the property? Yes /� No #of Accesses
4. Proposed Use:
g Permanents Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
*******₹*₹*₹₹**₹₹*₹*******₹*₹**₹*₹*******₹₹*₹*₹******₹*₹******₹**₹₹₹**********₹***********₹*₹₹******₹**₹₹*******₹₹₹₹***********
5. Site Sketch
Legend for Access Description:
AG = Agricultural
I H
RES = Residential r
O&G = Oil &Gas
D.R. = Ditch Road
O = House
• O = Shed jcs bopa550
Es = Proposed Access B fk<sr fait
A = Existing Access t
Ni �
D
7 7
***************************************
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:
•
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