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If s { a 1 L F , c I d { i . Cif l t1I I • • 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 IIIRoad File#: Date: 3- 31 -OS RE 11 : -1211- `, A Other Case#: 1. Applicant Name Nkret-4 \t F.LT • e-E. Phone (3 a3)la - 94/5 Address iv:Nuu CAL. 4 City $4 61i-Thl State CD Zip g_060,3 2. Address or Location of Access I VI$% Q . 4 , $Qs6tKor► to 8O(o O3 Section 31 Township O1 Range 1&Lb Subdivision Block Lot_,_ Weld County Road#: 4 Side of Road SzwirvA Distance from nearest intersection*JAT_E.EAT VI 3. Is there an existing access(es)to the property? Yes )( No #of Accesses pc. 1 �- 4. Proposed Use: Q Permanent C3 Residential/Agricultural 0 Industrial 0 Temporary 0 Subdivision $ Commercial 0 Other 5. Site Sketch Legend for Access Description: AG = Agricultural _I L__ RES = Residential O&G = Oil&Gas 4 D.R. = Ditch Road O = House '4 Cl = Shed Cry IIA =Proposed Access A = Existing Access Ni . ...0 F.0)-....A., ,,, 7 T-cli .---1 F OFFICE USE ONLY: Road ADT Date Accidents Date Road ADT Date Accidents Date Drainage Requirement Culvert Size Length Special Conditions _ U Installation Authorized O Information Insufficient Reviewed By: Title: • -9- Hello