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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 7 �a11
Road File#: Date: q- tl O5
RE # : yip Other Case #:
1. Applicant Name Charles //esei itaa Phone ('YIc) fie- O123 Address 21 plains Cart City Pert £Wf,ge State CC Zip 90$21
2. Address or Location of Access South west Carper 6 kick n' e wa el
Section JO Township -7N Range (7 UI Subdivision - Block - Lot (-
Weld County Road #: 21 Side of Road t tsr Distance from nearest intersection 75O Jdiitr/
X3. Is there an existing access(es) to the property? Yes n No if of Accesses 2 //
4. Proposed Use: .,/
W Permanent ,rsL Residential/Agricultural ❑ Industrial
U Temporary X Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural kICR Sy m`tI. pep I
RES = Residential ___J
O&G = Oil&Gas 0
D.R. = Ditch Road 3 '
O = House
O = Shed f7 tis,
A = Proposed Access 0
A = Existing Access /;,� a; 60
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to t/R rain . 1
2• P PioaeI ta441 Emit" Ikass.
3. [x;yliry fil ntoss k be (terlou'et 7 CO 'lel Pi
I y, come] sabkvisiod Patss.
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:
-17-
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