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2003-1585
WELD COUNTY ROAD ACCESS INFORMATION SHEET
Road File#: Date: d - 621-o 3
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.MJ4LJoLL e AulT,41 SR 4✓cN e Z Phone @7Z9 a-S51 -Or f 7
Address I f no Luca- C - City LA CfL/e State co Zip fro&Is-
2. Address or Location of Access }H45-/ wc✓- •u/
Section 9 g- Township 5 Range 6S Subdivision Block Lot
Weld County Road #: Side of Road Distance from nearest intersection
3. Is there an existing access(es)to the property? Yes No #of Accesses
•
4. Proposed Use:
PI Permanent ❑ Residential/Agricultural ❑ Industrial
O Temporary ❑ Subdivision ' t Commercial ❑ Other
*******************************************************************************************************************************
5. Site Sketch
Legend for Access Description:
AG = Agricultural
RES = Residential --I H
T
O&G = Oil & Gas L '
r D.R. = Ditch Road
O = House
O = Shed
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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 O Information Insufficient
'^ Reviewed By: Title:
EX IBR
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