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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 NE Cb/orA4/o (e/lw/ar ,luc �1ba.Uukero PhoneJ/d_)443 -jig
Address c 2..L'} to _ ' t,,i e arv� City c}lvtovyty, State Zip e07J
2. Address or Location of Access SW ( o� h¢_ S1.0
Section 35 Township 7 N Range 62. tw./ Subdivision Block Lot
Weld County Road #: (y Side of Road t4 z tk Distance from nearest intersection Q M ,1,e_S
3. Is there an existing access(es)to the property? Yes / No #of Accesses 1
4. Proposed Use:
$ Permanent 0 Residential/Agricultural 0 Industrial
0 Temporary 0 Subdivision 0 Commercial 0 Other
5. Site Sketch Se,� Svvve�
Legend for Access Description:
AG
= Agricultural
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road
0 = House
• '- = Shed i-
= Proposed Access `'
= Existing Access siaCk\°‘r‘
r S
3
rz / J
.......................................
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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