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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#: i / Other Case#:
1. Applicant Name 1.-.c1 EVEQIST/ At /(itseagt: Lywc M )Phone 3b3-2“)-2217
2217
Address LnS t'SV W?,OO City lej a&OA, State CO ziD $O(07O
2. Address or Location of Access Wit?t 2. 14 C42. /g'7 Ft. Lv7ia.. (SD SD 621
Section ZS Townships 2N Range ki711/S Subdivision Block -- Lot 3
Weld County Road#: /p Side of Road Distance from nearest intersection_20 f f- Wetta
3. Is there an existing access to the property? es No #of Accesses
4. Proposed Use:
a Permanent X Residential/Agricultural ❑ Industrial t�,� r
❑ Temporary ❑ Subdivision ❑ Commercial Other k/ vrt.f•Ac E
5. Site Sketch CD- n r35
Legend for Access Description' Q� 1„�} �
Los
—
AG = Agricultural
.----] eit)RES = Residential
O&G = Oil&Gas W 17' I t�
'r D.R. = Ditch Road - 1{uosot..4 Sleds
6 = House
O = Shed 0X7 - ail#caS midis
A =Proposed Access 044
• =Existing Access _sow, I•
1D._-
it -raft,\LP
iv& 44-kitetc-ExAtt ill%-e
A 5.14L suit
B &i t.ca
***i ********rti+.n.*a***+MyaN*+***arInI^*Nw `-7� A ��
OFFICE USE ONLY: 7O 1 To �FY'�
Road ADT
Date Accidents
Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions— ❑ Installation Authorized ❑ Information Insufficient
Reviewed By: Title:
-7-
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