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/.. APPENDIX B
WELD COUNTY ROAD ACCESS INFORMATION SHEET
Weld County Public Works Department Date: ✓3l Z/0l
1 111 H Street,P.O.Box 758, Greeley,CO 80632
Phone: (970)356-4000,Ext. 3750 Fax: (9'700�)304-6497
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1. Applicant Name 1,144/ t / /I21 �m,W✓t/ Pho e 3O3-333 -Z772- !
Address n5---7 ,jAYLE if City 4W.6/07 StateState‘LL Zip 90S-01/
2. Address or loc ion of access 7ZS7 nil,&t ,5f. 11/tierllri?/ a. s/Xo1
Section H Township Range 6 7
Subdivision bAL1ld�FQ f 44-5 /l Block �/A Lot t-3// 850ZCZ7
Weld County Road # it, Side of Road
QiT/t Distance from nearest`intersection
3. Is there an existing access to the property? Yes /x No #of accesses 1
4. Pr posed Use:
$ Permanent 'XResidential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision ❑ Commercial ❑ Other
***********************************************************************************************************
5. Site Sketch
Legend for Access Description: _I H
AG = Agricultural 4 �blw 4
r°ES = Residential ..)l :.
J&G= Oil&Gas
D.R. = Ditch Road
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4 51/b
/Wit 514-
**********************************
OFFICE USE ONLY:
Road ADT Date Accidents Date
Road ADT Date Accidents Date
Drainage Requirement Culvert Size Length
Special Conditions
***********************************************************************************************************
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❑ Installation authorized ❑ Information Insufficient
Reviewed By: Title: EXHIBIT
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