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Road File #:
RE#:
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:
ii -3-o8
Other Case #:
1. Applicant Name 2a pi/ /J CJ✓Ij-..D et --1-C Liu.1 Phone 3O3- 233 g ?sal'
Address IW! CI fate A,t(._ City y‹,:+L,,et,.1 State it Zip 40124
2. Address or Location of Access I %VI ((race_ (Lye Z to LIup'h'H1 CC '3062 I
Section ZS Township / Range 67 Subdivision Block 7 Lot _5
Weld County Road #: to Side of Road Distance from nearest intersection
3. Is there an existing access(es) to the property? Yes / No # of Accesses
4. Proposed Use:
❑ Permanent U Residential/Agricultural U Industrial
U Temporary ❑ Subdivision
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
A = Existing Access
Ni
OFFICE USE ONLY:
Road ADT
Date Accidents
Road ADT
Drainage Requirement
Special Conditions
Date
Si Commercial ❑ Other
Date
Culvert
Accidents
Size
Date
Length
❑ Installation Authorized L] Information Insufficient
Reviewed By: Title:
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