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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: l r7}ILi 9
RE # : Other Case#: q
1. Applicant Name ( •`?G�.c d- �t �7f L l(ex"( n G Phone 6?—7O 'o2 (t-( — 3j4 7
Address g 13 1 /pa ��-e j22-0a.of City✓✓ I-,6-Yp1Y3 WI WIf State CC) zip ff'VSDv
,9I 2. Address or Location of Access 31 die r2o tf/1
Section I 1 Township 2. Rang I./7 Subdivision alyt- jIQ k Lot out
Weld County Road#: Side of Road Distance ffom rye rest intersection
3. Is there an existing access(es) to the property? Yes No #of Accesses
4. Proposed Use:
❑ Permanent ❑ Residential/Agricultural ❑ Industrial I//
❑ Temporary ❑ Subdivision ❑ Commercial Other /60710 R;
*******************************************wt******************************** *************************************************
5. Site Sketch
Legend for Access Description: I I
AG = Agricultural
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road
= House
• a = Phed
roposed Access
= Existing Access a
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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:
-9-
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