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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 '7 ' 5 Pk N r\ M c Gs-Tors Phone "220 3 857 380 9
Address 1 S U b 5 L iv (5 &NE / P o +' ay. 5 �i N City rc L,s Pvo rr3 State CC Zip '80 1, �#
2. Address or Location of Access
Section 2.7 Township 2- Range 4- C Subdivision Block 'f 3 Lot q
Weld County Road #: Side of Road Distance from nearest intersection
3. Is there an existing access(es) to the property? Yes i-- No # of Accesses
4. Proposed Use:
a Permanent J Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ar Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil & Gas - C /as D.R. = Ditch Road
0 o = House
O = Shed
A = Proposed Access
A = Existing Access
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OFFICE USE ONLY:
Road ADT
Date Accidents Date _
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions •
LI Installation Authorized ❑ Information Insufficient
Reviewed By: Title:
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