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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:
RE # : Other Case #:
1. Applicant Name JgsoaJ S. SLATEn. Arlo LISA Al. I OFF= 7,uffE& Phone 97D X21- 3bO
Address SS G"7 (.u.C rfL. Q b City r-t.ru-r CoLL.l.nl S State Co Zip 8o S24-
2. Address or Location of Access B5(o-) w• c.t. g6 F.n-i CoL-LiaS, Co 6oSZ4
Section S.2) Township 13 N Range (/1 u' Subdivision Block Lot /
Weld County Road #: Side of Road N\o&h Distance from nearest intersection IISOy pi-
3. Is there an existing access(es) to the property? Yes y No # of Accesses 2 (C1(1..CulAt- b1-IUE)
4. Proposed Use:
Permanent Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential
O&G = Oil & Gas
D.R. = Ditch Road
O = House
O = Shed p = Proposed Access Iq
= Existing Access rLox • ,
NT a
(
EL,
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
❑ Installation Authorized ❑ Information Insufficient
Title.
Reviewed By:
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