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TITLE, FLOOR PLAN rykALEdM'Ir_O' DATEnno4
BIBLE BAPTIST CHURCH
2020 CLUBH 1O USE DR., &REELEY, PLANNERS CO Al
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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)3046497
Road File#: Date:
RE# : Other Case #:
1. Applicant Name ti`i- I _ i -4-A Phone g3, 2 'JLDrt t
Address .t wit City nitir'fi��� �StatB.C Zip,�io I
2. Address or o ation of Access GGk-�11! *Iv", $�y�_ Block
�>�}�� —
Section �,jTownship�_Range Subdivision 1.,1y'}- Block ' ZJ Lot O Weld County oad#' ` Side of Road - Distance from nearest intersection`� �1*/-7,
3. Is there an existing access(es)to the property? Yes X No #of Accesses
4. Proposed Use:
❑ Permanent O Residential/Agricultural i ❑ InCommercial
1.k19(
V y� ( navzl�
❑ Temporary O Subdivision O Commercial Other /�/1'Z c- ;:1)
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential , . .. .,,J H
O&G = Oil&Gas I 1 . te; Y�
D.R. = Ditch Road
0 = House 0
O = Shed ��3
A =Proposed Access 1 Is a
A = Existing Access
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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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