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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:
Other Case #:
1. Applicant Name /7"-Aceiy ' it/eV?), iee,e's Phone7c?O—Z03-3S$v
Address 29 Z S [—tic 9c- City X2eneric.,`g State itzt. Zip gO&, i
2. Address or Location of Access Lana -5- en &sc e ) • $04,cj
Section 4P5 Towns�tipp Opt Range O V Subdivision Bloc Lot
Weld County Road #: 39fc Side of Road S9 Distance from nearest intersection I/2r -.4
3. Is there an existing access(es) to the property? Yes 4 No
# of Accesses
4. Proposed Use:
Permanent ,X Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision X Commercial E Other
***********************************************************************************************************************************
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil & Gas
D.R. = Ditch Road
= House
❑ = Shed
A = Proposed Access
1 = Existing Access
N
***************************************
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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