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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 #: r n Other Case#:
1. Applicant Name / O. 1 a /714OU v /- Phone
Address YzCeJ WC ' 2YAl City j0nghiDWI- State ('D, Zip 627,67,q
2. Address or Location of Access 49'01 /,UC Jam' ) y17 /oil it«on i( 6... d ✓/
Section rQ Towns ip .Y Al Range (o/7, ,r) ubdivision Block Lot
Weld County Road#: t 3 Side of Road /V0/ Distance/ from nearest intersection //U Jr, e
3. Is there an existing access(es)to the property? Yes // No # of Accesses
4. Proposed Use:
0- Permanent 0 Residential/Agricultural ❑ Industrial
0 Temporary 0 Subdivision Commercial ❑ Other
5. Site Sketch
Legend for Access Description: __I I
I
AG = Agricultural •
L_
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road
O = House
O = Shed
A = Proposed Access ❑
• =Existing Access 0
Ni
Iç weLq �: II
Ft
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
O Installation Authorized O Information Insufficient
Title:
Reviewed By:
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