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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 W;12-tt4o4M CELAI Cat/3 Phone �zd- Y QV- Z.2-/o
Address 2044£1 Coak1 3,y QDA-G / City BErtrtiomo State CO Zip Ian
2. Address or Location of Access 73,44& cou /anit-O /
Section I ' Township 4A1 Range 6t3W Subdivision Block Lot
Weld County Road #: / Side of Road Distance from nearest intersection
3. Is there an existing access(es) to the property? Yes X. No #of Accesses 2--
4. Proposed Use:
❑ Permanent 0 Residential/Agricultural 0 Industrial
❑ Temporary 0 Subdivision 0 Commercial X Other U S 1Z
5. Site Sketch
Legend for Access Description:AG = Agricultural I I �Sb6 i/f-t�,/
RES = Residential
O&G = Oil &Gas
D.R. = Ditch Road /16csil Mi-
O = House t
O = Shed s s
r _ 1
A = Proposed Access I °
A = Existing Access RCS $ t_ — - -'
l 3, �i Ref t obJ n Ai-
NT (test OCatnen-
7 1------
***************************************
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
O Installation Authorized 0 Information Insufficient
r Reviewed By: Title:
-9-c4P .
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