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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: 9• )C - 0 1
RE# : Other Case#:
1. Applicant Name%w/N F KS DIESEL / QFemirssC, /NG Phone 303'960-90/y
Address 177/6 wog 13 City ff►rrlsvILCL' State co Zip $o65/
2. Address or Location of Access
Section Township Range Subdivision Block Lot
Weld County Road#: I, Side of Road 4057-f Distance from nearest intersection t Nilb6
3. Is there an existing access(es)to the property? Yes Ve No #of Accesses
4. Proposed Use:
Permanent ❑ Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision U Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road
0 = House
= Shed ,g„,i K
A = Proposed Access
A = Existing Access
poa
Ni .aMt
**************************************
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
O Installation Authorized ❑ Information Insufficient
Reviewed By: Title:
-9-
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