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SITE PLAN REVIEW (SIR -38q
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Road File #:
RE#:
1. Applicant NaiD
Address )3')I
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
Date:
rN �
zr- / City
Other Case #:
Phone - 7 7-:), - 96,93
1-,1-i j mei — State (L Zip g
2. Address or Location of Access J,3 y p. )
Section C) Township '� A/ Range G,X Lt:,) Subdivision Block Lot
Weld County Road #: I Side of Road Distance from nearest intersection l" nu.
3. Is there an existing access(es) to the property? Yes ✓ No # of Accesses
4. Proposed Use:
Permanent 0 Residential/Agricultural U Industrial
U Temporary O Subdivision U Commercial 0 Other
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
***************************************
OFFICE USE ONLY:
Road ADT
Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
U Installation Authorized O Information insufficient
Reviewed By: Title:
-9-
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