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Address or Location of Access we ri/n too St Section S TownI�hip Range tL! Syybdivision - Block - Lot - Side of Road SOY f¢ ( WCR Weld County Road#: �7 Distance from nearest intersection Z/000 ter 0� 3. Is there an existing access(es)to the property? Yes X No #of Accesses 4. Pro o ed Use: a Permanent ❑ Residential/Agricultural 0 Industrial ❑ Temporary, Subdivision ❑ Commercial 0 Other 5, Site Sketch Legend for Access Description: AG = Agricultural RES = Residential -I H. O&G = Oil Gas D.R. = Ditch Road o = House = Shed 0 re 0 ,� 6 (`9) A = Proposed Access r A = Existing Access --i...--. • NT s qP 41tS 1 DP I. Exl ou D;tc� Rood Access to ,, ., I-emu/4 . . :, HG ? EXlstIo f�y. Ii tees to be Rtmovrd, 7 „id, county Rood e4 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: TNe: • -17- • File contains oversized Plat Map of Recorded Exemption RE-3684 • Please see Original in File •
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