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Weld County 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:
RE#:
1. Applicant Name ✓o„ I g (tee
Address i/7c3-J,l/;_e Sr
2. Address or Location of Access
Section 3 3 Township
Side of Road
Other Case #:
Phone .10.3-3516 S'DY3
City fir Lt, State Co Zip 21"O6 2i
//o D / /r ESr OF SC 47, Wen_ sEz7A,I./ 33,
�5 _� Subdivision — Block Lot
NCR 7x/ Distance from nearest intersection—Tt/E
3. Is there an existing access(es) to the property? Yes K No # of Accesses .Z
4. Propo ed Use:
Permanent ❑ Residential/Agricultural U Industrial
❑` Temporary ❑ Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG
RES
O&G
D.R.
0
O
A
•
= Agricultural
= Residential
= Oil & Gas
= Ditch Road
= House
= Shed
= Proposed Access
= Existing Access
NI
OFFICE USE ONLY:
Road ADT Date _
Road ADT Date _
Drainage Requirement Culvert
Special Conditions
Accidents Date
Accidents Date
Size Length
❑ Installation Authorized
❑ Information Insufficient
• Reviewed By:
Title:
-9-
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