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MONTROSE COUNTY LAND USE DEPARTMENT <br />P.O. Sox 1289 <br />Montrose, CO 81402 <br />970-249-6688 <br />LAND USE UPGRADE QUESTIONNAIRE <br />This form will assists you and our staff in streamlining the permitting process. Please fill in all <br />applicable spaces and attach legal description with any supporting documents (location maps, <br />plot plans, etc.}. Thank you! <br />(PLEASE PRIlV77 <br />Applicant's Name: /~!r ~{ ~ r,4 ~ Day Phone: 2 9 S'3 & <br />Applicant's Mailing Address: S~'~ G~S. 3J on iL~~.vfros~ CO <br />Property Owner Name - Sams Different <br />PROPERTY LOCATION <br />' Legal description of property -Obtain 2 copies of the Property Record Card from <br />the Assessor's Offtee. If you have muttipie properties, be sure that you obtain the <br />applicable record card. Attach copies to this questionnaire. <br />` Existing site address(es) for this property <br />Street address dy <br />'Property is currently !!8z ~ ~ acres in size. Property is zoned:/ /,aN <br />' Property has county road frontage on Rd/Dr/Hwy <br />' Property is Lot # of <br />Subdivision <br />PAST HISTORY <br />' Number of residential dwellings located on property O Number of outbuildings 0 <br />` Number of approved residential andlor commercial accesses,existing on property O <br />' Number of farm accesses existing on property ~_ <br />' List addresses previously assigned to existing btdgs. <br />' list permits previously obtained for this property: Bldg. Septic Access <br />' Drinking water source: .t~Ne Sewage source: No ~e <br />PROPOSED UPGRADES (please check all that apply) <br />' Obtain Site Address 911 Address Sign <br />'Obtain Building PermK 'Mobile PennaneM Foundation Permit <br />' Obtain Septic Permit 'Mobile Temporary Foundation Permit <br />` Obtain Access Permit 'Obtain Floodpiain Permit <br />' Subdivision of Property 'Other <br />" Request to be considered for Exemption from Local Road Building Requirement <br />' Request for Change in Zoning District PO FPD <br />'Request for Variance from Access Palicy <br />' Request for Special Use Petmit / <br />e V""'" 1 ~~ J / <br />Signal re o andown~. ppik~nt...or authorized agent (Please circle) Date <br />forms quest Mar 1997 <br />