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ID
• WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Department of Public Works
1111 H St PO Box 758 Greeley CO 80632
Phone: (970 )356-4000 x3750 Fax: (970)304-6497
Road File#: Date:
RE # : Other Case #:
1. Applicant Name we.% d Ccvv. Phone tit)) "too- .49(.
Address t��t k ist-. City GYa..\n State_ea_Zip 80G3t
2. Address or Location of Access SciaA S\ 4 Gv-...\...\03 C s—s (',wo tIni
Section 33 Township G r1 Range GCt.) Subdivision NIA Block Lot
Weld County Road #: 5 C1 ' A.,t Side of Road \w10 +\ Distance from nearest intersection—7O(11
3. Is there an existing access to the property? Yes X No #of Accesses
4. Proposed Use:
❑ Permanent ❑ Residential/AgriculturalO Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ,....la---Other_prconwteN
****..e*e************...e****************.e:t-...x.x.********************...e****e.....*****a*.....e**
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential lwi-0
I---
• O&G = Oil&Gas
D.R. = Ditch Road
O = House
O = Shed
A = Proposed Access f
A = Existing Access r- AG
oat
Ni °
c0 get******************************** 7 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:
•
11
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