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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 #: Date: L- \ Lk- 0(1
RE # : Other Case #:7 C_N tQ -mac Ac,LL;
1. Applicant Name >C C r u n;, Phonec Y`t\24'.37
Address S ‘S Locj 7S City (' (.2-z c State CO Zip cart,v/
2. Address or Location of Access \ 14
Section —ZA„ Township 10 Range L1 Subdivision Block Lot Q
Weld County Road #: 23 Side of Road CxThe.°-,4 Distance from nearest intersection \°p
3. Is there an existing access(es) to the property? Yes '( No # of Accesses
4. Proposed Use:
Permanent 4 Residential/Agricultural U Industrial
Temporary ❑ Subdivision .10 Commercial ❑ 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
NT
UDLQ t v2
OFFICE USE ONLY:
Road ADT
Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation Authorized ❑ Information Insufficient
Reviewed By: Title:
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