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APPENDIX B
WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Public Works Department
1111 H Street,P.O.Box 758, Greeley,CO 80632 Date: `,f.C• 1 ZOO Z
Phone: (970)356-4000,Ext.3750 Fax: (970)J 304-6497 (/'� p
1. Applicant Name CoggrN L E EcoSS Phone(.3o 3) 776- 7638
Address IYSoq WCR 3 City Lo.jcn,otr State (.O Zip or
� Oc✓
2. Address or location of access I ys0 y (,t/CR 3 toN4n+our\ CO. Sara y
Section 2O Township 3 Range 68
Subdivision Block g
Weld County Road # Lot
.71 Side of Road 2 Distance from nearest intersection (die NAG F 11 SCE
•
3. Is there an existing access to the property? Yes X No #of accesses 1
4. Proposed Use:
❑ Permanent 18[ Residential/Agricultural O Industrial
❑ Temporary ❑ Subdivision O Commercial O Other
5. Site Sketch
Legend for Access Description: I wc.R I I tY
AG = Agricultural gL 44;,RES = Residential , 11
Ll&G= Oil&Gas l,
I. = Ditch Road
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**********************************
OFFICE USE ONLY:
Road ADT Date
Road ADT Accidents Date
Date Accidents Date
Drainage Requirement Culvert Size
Length
Special Conditions
***********************************************************************************************************
O Installation authorized ❑ Information Insufficient
I awed By:
Title:
8
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