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Longmont IG NBountlary
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WELD COUNTY ROAD ACCESS INFORMATION SHEET
Road File#: Date: /7-,ZS_ DS
RE#:
Other Case#: 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
1. Applicant Name fries Avfly s 4cAay hone-94'O -.51,--le)
Address // dcsr �/y Rv City State e.e." Zip ,9Qg-r.3
2. Address or Location of Access 774'5/09 2 //9 „(O �jat)T� J Y5/1 /
Section Township ,8 Ran a AA, Subdivision Block Lot —
Weld Countyyoad#: Side of Road Distance from nearest intersection
3. Is there an existing access(es)to the property? Yes X No #of Accesses /
4. Proposed Use:
❑ Permanent ig Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial 4 Other Su,_ _____ ___
5. Site Sketch
Legend for Access Description:
AG
= Agricultural
--I H
RES = Residential
O&G = Oil&Gas
+^- D.R. = Ditch Road
O = House
O = Shed
Ni O. a
I[
IMP
.......................................
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:
CERTIFICATE OF CONVEYANCES WELD COUNTY
4,-.
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