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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: 571 /al
RE# : Other Case#:
1. Applicant Name SvsV,„ Nab S?in,'kv Fri k Phone -cw s F l - OM,
Address 1E 45 Lgvrvi Lr City • XotnS+cw State GC) Zip soy 3N
2. Address or Location of Access .1-3 1101 C-K I S '3'01-N2,4046n t CC 9o53'(
Section o Township q Range to Subdivision Block Lot
Weld County Road #: IS Side of Road iNey - Distance from nearest intersection 4OO4}
3. Is there an existing access(es) to the property? Yes X No #of Accesses
4. Proposed Use:
Permanent ❑ Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision Commercial ❑ Other
*******************************************************************************************************************************
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential W�.� •
• O&G = Oil &Gas
D.R. = Ditch Road
0 = House
O = Shed 7u
A = Proposed Access 3'
= Existing Access
Ni
***************************************
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-
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