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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 # : (�(\ \ \ \ Other Case #:_ _
1. Applicant Name , 1 1\ \ ' \,L 4'111'4 Phone 9 )0 5" " .5a6a
Address all Z Cann � { Z0 Nd bL C City Wxl Lo11�nh State C n zip 4-0544
2. Address or Location of Access
Section a.% Township oI h.) Range i-,1, I.) Subdivision Block Lot
O1
Weld County Road #: ADD Side of Road N Distance from nearest intersectionAld-�
3. Is there app existing access(es) to the property? Yes ✓ No # of Accesses N
{J(V\�Lanat is pnm�opOST:A� coc ntfq 5\ k oag5 on WLII a#4, ana ha.J Auo5�i. \t0 1-0,1 1�1
4. Proposed Use: W(-0. WO icA acudh --11) 1-or 0 'lo be O,slenryl.:AvA \AtU
GI Permanent 0 Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG
= Agricultural
RES = Residential
O&G = Oil&Gas
D.R. = Ditch Road
= House
= Shed
A = Proposed Access .. '-
• = Existing Access
NT
ago' I I
1,acR I Do
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:
-8-
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