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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 SI-vJ a.v ck CO Phone
Address C/o .%4.*7UJt}c+-s r RAJ. 7•*" S+' City [-,-rcc(iel State CO Zip $O63 i
74O
2. Address or Location of Access 21 ( WGe-. SS.S
Section I I Township ,j Ranged Subdivision Block Lot
Weld County Road #: SS.S Side of Road A) Distance from nearest intersection — �2 ',Zit
3. Is there an existing access(es)to the property? Yes )< No # of Accesses
4. Proposed Use:
❑ Permanent ja. Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG
= Agricultural
RES = Residential —I H
O&G = Oil &Gas
D.R. = Ditch Road tv
O
O = House /��
= Shed
A = Proposed Access °o //
A = Existing Access �� )
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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:
-9-
--- FEMA Community Panel
Panel Numbers 080266 0489C
Map Date: 9/28/82
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