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WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Department of Public Works
111 H Street, P.O. Box 758, Greeley, Colorado 80632
Phone: (970 )356-4000, Ext. 3750 Fax: (970) 304-6497
Road File #: Date:
RE#:
1. Applicant Name *X/ ef J/ nr,e Id Phone 2S--.Address7.�Q�% a: A- et City t‘rea°//State /
2. Address or Lgcation of Access 2 CW AZ C St' G(e, e/v, / vr%n O p�Ob-..?/
Section „3 6 Township Ga Range 4h tit bdivision Block Lot
Weld County Road #: 4//' S f Side of Road Distance from nearest intersection 704
3. Is there an existing access(es) to the property? Yes No # of Accesses/
Other Case #:
4. Proposed Use:
U Permanent ❑ Residential/Agricultural ❑z Industrial
❑ Temporary U Subdivision /R+l(
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil & Gas
D.R. = Ditch Road
= House
= Shed
A = Proposed Access
• = Existing Access
OFFICE USE ONLY:
Road ADT
Date
NT
Accidents Date
Road ADT Date
Drainage Requirement Culvert
Special Conditions
Co m m ercia l
Accidents
Size
77/1
Zip -6-u23
❑ Other
Date
Length
❑ Installation Authorized
❑ Information Insufficient
Reviewed By: Title:
CERTIFICATE OF CONVEYANCES WELD COUNTY
STATE OF COLORADO DEPARTMENT OF PLANNING SERVICES
COUNTY OF WELD
-10-
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