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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: f' a cg -1 a
RE # : Other Case T #:
\ . � S wstd or
1. Applicant Name ,� (,(,f l,(_( , 4 ii cc C t Sc it Phone 770 - ,9.)a 7 - `/a tIs
Address 9c/C1 (Al . 71% st . City cOV(LANIQ State co Zip C 17
2. Address or Location of Access 2i 4 Q a 1-- - As AGC <SS icd. Or WC-le— t7
Section Township Range Subdivision Block Lot
Weld County Road#: q4, Side of Road Distance from nearest intersection
3. Is there an existing access(es)to the property? Yes X No 3 #of Accesses
4. Proposed Use:
❑ Permanent ❑ Residential/Agricultural ❑ Industrial • 714tdr -hi
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other N re, ><-i`Vt Q I Ai r
**********************************************************************************************************'ti***********************
5. Site Sketch
Legend for Access Description: ____J L.._
WC '
AG = Agricultural
RES = Residential fl. 'Q
O&G = Oil & Gas a Cl
D.R. = Ditch Road -
= House fp r� R `'
• = Proposed Access
• = Existing Access
NI - 1 F---
.........**,...,..........,
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:
-9-
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