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APPENDIX B
WELD COUNTY ROAD ACCESS INFORMATION SHEET Weld County Public Works Department Date: ._ /L/7/yn
933 North 11th Avenue, P.O.Box 758, Greeley, CO 80632
Phone: (970)356-4000, Ext. 3750 Fax: (970)352-2868 ��
I. Applicant Name d�t l�r<r( i 1 C� �� /�I C P7 A Phone (1/117) � '
Address 919j�0 !) c City ,7-4—te-1 y Stated; Zip 3
t7.2 (I/
2. Address or location of access *L q qq6 S 7
Section .. Township `i Range e, y
Subdivision Block Lot
Weld County Road # S 7 Side of Road # Distance from nearest intersection "rf, fY
3. Is there an existing access to the property? Yes / No #of accesses r'
4. Proposed Use:
® Permanent ❑ Residential/Agricultural ❑ Industrial
❑ Temporary ❑ Subdivision 18 Commercial ❑ Other
***********************************************************************************************************
5. Site Sketch
Legend for Access Description: AAA
ARG= Agricultural dti�4 �t' .(T£t \,
RES = Residential cownic
O&G= Oil& Gas ((---- ---
O.R. = Ditch Road
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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 ❑ Information Insufficient
reviewed By: Title:
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