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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: 2 tf4 /b`/
RE# : Other Case#:
1. Applicant Name 12xnre.r\'r Gecc, A- \JOSLi Phone 97c-g97-3/gg
Address Po t3ux 3 cc W Q.II:no Pen City State Co Zip cov-ii
2. Address or Location of Access 11q5-6 6 C. R 17 Nonni (do '0&ci g
Section 28 Township 9 Range 67 Subdivision Block Lot
Weld County Road #: I' Side of Road as1-- Distance from nearest intersection Yy Ph l-e,
3. Is there an existing access(es)to the property? Yes )( No #of Accesses_
4. Proposed Use:
❑ Permanent I Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
5. Site Sketch
Legend for Access Description:
AG = Agricultural CR ID
RES = Residential
O&G = Oil & Gas
D.R. = Ditch Road
= House A 0-
Shed 5ogrre
A = Proposed Access
• = Existing Access o %Ai
NT
Czloo
OFFICE USE ONLY:
Road ADT Date Accidents Date_
Road ADT Date Accidents Date_
Drainage Requirement Culvert Size Length
Special Conditions
O Installation Authorized ❑ Information Insufficient
Reviewed By: Title:
-8-
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