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Weld County Road #: Side of Road
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: 3 /% I /Oct
RE # : Other Case #:
1. Applicant Name { �� � „ Phone Q70 3 * I 74 V I
Address IyL5q ' Z City C,rce tc-j State Cy Zip cLn3 )
2. Address or Location of Access ly Z Sc%
Section /(.0 Township 0 L Range Cato Subdivision Block Lot
Distance from nearest intersection
3. Is there an existing access(es) to the property? Yes X No # of Accesses
4. Proposed Use:
Permanent Residential/Agricultural Industrial
Temporary Subdivision Commercial Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O84 = Oil & Gas
D.R. = Ditch Road
0 = House
= Shed
A = Proposed Access
A = Existing Access
OFFICE USE ONLY:
Road
Date
Road
Drainage Requirement
Special Conditions
ADT
Accidents
ADT
Date
Date
Culvert
Accidents
Size
Date _
Length
3 s'L-
Reviewed By:
Installation Authorized Information Insufficient
Title.
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