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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
Road File#: Date:
RE#: Other Case#:
1. Applicant Name hem an d ga I11/ Iforma n Phone J2(2_,)-s- 3---7W/
Address (043 LUCI2 I6 City fr jn State O1O Zip 6O(OO3
2. Address or Location of Access (0-I S (AL I2 to Br tshi"Dn (ZL £f(oO3
Section 19 Township i Nor+k Range (07 Ulesf-Subdivision Block Lot
Weld County Road #: (p Side of Road Nod+ Distance from nearest intersection 'Am(it
3. Is there an existing access(es)to the property? Yes X No #of Accesses
4. Proposed Use:
U Permanent of. Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision U Commercial JA Other IV Slat T1'UWLS in Ith
₹*₹*********************₹₹********₹₹******₹****************₹*****₹*₹****₹**₹*******₹**************₹*iii**********₹*₹****₹₹*****
5. Site Sketch
Legend for Access Description: n & n
AG = Agricultural A & I A A 6
RES = Residential Lei
O&G = Oil&Gas
D.R. = Ditch Road n
O
•O = House
= Shed I'�G
A = Proposed Access %, i La Lf
A = Existing Access AG I fl
Ni .k V
17 AAA R&
***************************************
OFFICE USE ONLY:
Road ADT
Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation Authorized Li Information Insufficient
Reviewed By: Title:
•
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