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EXHIBIT
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2009-0728
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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 #:
RE#:
1. Applicant Name
Address
rut,"
Date: 7- V— O
Other Case #:
PiK LG L Phone 77e _3,1'-YofZ
City ere/6;j__State Ca Zip �." Y
2. Address or Location of Access 912 / 6
Section i Township /if/ Range � Subdivision Block Lot
Weld County Road #: o r Side of Road Distance from nearest intersection 5O6
3. Is there an existing access(es) to the property?
4. Proposed Use:
S Permanent U Residential/Agricultural
❑ Temporary ❑ Subdivision
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil & Gas
D.R. = Ditch Road
O House
Shed
A = Proposed Access
• = Existing Access
Ni
Yes ^ No
# of Accesses
Industrial
Commercial ❑ Other
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wOP, I
OFFICE USE ONLY:
Road ADT
Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
Reviewed By:
❑ Installation Authorized
❑ Information Insufficient
Title:
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