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Road File #:
RE#: 1
1. Applicant Name PC? tm`c,10 I -c owv Phoneglo-356-9100
Address 131.4 (Vor TF4 tt.re.tLt` City fteat State C_ Zip '206,3 1
2. Address or Location of Access 3 1 R9 5 W c Is L1
Section 28 Township 6 ,v Range 6% f.✓ Subdivision Block Lot
Weld County Road #: 'j 3 Side of Road vies j- Distance from nearest intersection ')z v,,; )
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: 1O -28-08
Other Case #:
3. Is there an existing access(es) to the property? Yes L/ No
4. Proposed Use:
Vtermanent 0 Residential/Agricultural industrial
0 Temporary O Subdivision 0 Commercial 0 Other
5. Site Sketch
Legend for Access Description:
AG
RES
O&G
D.R.
O
0
A
•
= Agricultural
= Residential
= Oil & Gas
= Ditch Road
= House
= Shed
= Proposed Access
= Existing Access
OFFICE USE ONLY:
Road
Date
Road
Drainage Requirement
Special Conditions
ADT
Accidents
ADT
Date
Date _
Culvert
# of Accesses
r--j"a-i
Accidents
Size
Date _
Length
0
Reviewed By: _
Installation Authorized
0 Information Insufficient
Title:
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