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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: /4/01/47001
RE# : Other Case #:_
1. Applicant Name }L. ,tktl�, ESLffrec 7 C.i7g. .it__ Phone .3(13 - f4--77t6
Address •37O VAti' ty-gb--cA( ' tr - City Lµ{_t.(ON' . State (,r Zip PrIZS
t' D YJc it._ Z8(3G'-- `TQ //
2. Address or Location of Access A �ct(44.t zc5`7 .3 W ,t-t.E./, �clt r4 pt /de,ft ( 7(c 04ti,ti,kt(6tj
Section 5 Township 11 tileta(Range(0Gcklfh Subdivision Block Lot
Weld County Road #: Side of Road i<- r Distance from nearest intersection 3 644L-S
3. Is there an existing access(es) 4 C to the�rproperty? Yes No #of Accesses z-
A'fLtl t Vet (!7' T,T v 'eltrMtt' .PictntLfln- cc iViA 4-)..41-(TiVrictrl•
4. Proposed Use: ./
gPermanent ❑ Residential/Agricultural ❑ Industrial / A ruKA� 43
Temporary ❑ Subdivision ❑ Commercial 4, Other f ::37-0-tied
5. Site Sketch
Legend for Access Description: ��""
AG = Agricultural D 114 I AA
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road O,r '
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O = House
AEA
O = Shed
A = Proposed Access Q N
• = Existing Access ./CI 4 I 4•C Nt ak ,��� -G .% r (4-n
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OFFICE USE ONLY: M
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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Please see original
in File
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