The residential and institutional land uses along the route contrast sharply with the nearby and nearly parallel route formed by 1100 East and Highland Drive (part of former SR-152), which has commercial and retail uses along a very high percentage of its length, and SR-181 in effect served as a bypass of the congestion associated with that commercial development.

In the route's first two miles (mostly within modern Millcreek Township), a small military logistics facility and St. Mark's Hospital were located on the west side, the latter at the junction with 3900 South.

The highway expanded to four lanes past SR-171 and veered northwesterly through a major commercial area, therefore going slightly out of the alignment of 1300 East in the Salt Lake County grid system and becoming Richmond Street through southern Highland Park.

At Highland Drive, the highway widened to six lanes (plus, for the first time, frontage roads on the west side).

In 1957, the highway was extended south by Commission to 1300 East (SR-152), which at that time ran along Highland Drive in Sugar House.

On 7 December of the same year, the remainder of the route was transferred to Salt Lake County's jurisdiction.