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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: L{AO0Z- /U7
RE#: Other Case#:
1. Applicant Name MiCH46L a MELptiIt Sccr Phone C97C ,134-39-73
Address -C Bo -73(c City CrNut Ter.) State QC Zip SC4, ao-
2. Address or Location of Access _2'44057 a3iZ° fq-YE. , EA re rl , CC it to(c
Section 1 r5' Township IN Range (cc{ ki Subdivision em-1 F'LW Block /7 Lot /3
Weld County Road#: Side of Road Distance from nearest intersection
3. Is there an existing access(es)to the property? Yes I/ No #of Accesses /
4. Proposed Use:
❑ Permanent O Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial Id Other I Ai tic"it &_Si AIt.SS
5. Site Sketch
Legend for Access Description:
AG = Agricultural C S I /1C IE-S.
RES = Residential Li/P.
O&G = Oil&Gas
D.R. = Ditch Road I .
i7 = House i
O = Shed `t c
v 2
A =Proposed Access M
A = Existing Access
NT s o
AG- in G- AG
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: Title:
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