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MONTRUSE COUNTY LAND USE DEPARTMENT <br />P.O. Box 1289 <br />Montrose, C0.91402 <br />970-249-6698 <br />LAND USE UPGRADE QUESTIONNAIRE <br />This form will assists you and our st9ff in streamlining thepermitting process. Please fill in all <br />applicable spaces and attach legal description with arty supporting documents {location maps, <br />plot plans, etc.). Thank you! <br />(PLEASE PRlN7) <br />Applicant's Name: ~f/ck i1.Grirv Oay Phone: <br />Applicant's Mailing Address: S~~ '~30 ~ //jfa,vfy`ose ~ ~O /yo <br />Property Owner Name -Same / Different <br />PROPERTY LOCATION <br />` Legal description of property -Obtain 2 copies of the Property Record l,.atd from <br />the Assesspr's Office. If you have-mr~tipie properties; tie sure-that you obtain the. <br />applicable record card. Attach coP~ to this questionnaire. <br />" F~cisting site address(es) far this property <br />Street address 'ty <br />'Property is currently ;3 ~ . - = acres in s¢e. Property ispzoned: <br />' Property has county road frontage on K~,~+ k I d ~oAd Rd/Dr/Hwy <br />' Property is Lot # of Subdivision <br />PAST HISTORY <br />' Number of residential dwellings locaited on property D Nrxnber of outtwildings <br />' Number of approved resideri6ai andfor commercial accesses existirfg, orr pmpetty D <br />' Number of farm accesses eirisfarg on property:. <br />• List addresses previously assigned to existir>9 bkigs. <br />' List permits previously obtained for the property- Bktg. Septic Access <br />' Drinking water source:- ,r ore Sewage sourx~: ,~b.~ ~ <br />PROPOS€D UPGRADES (please check ail that apply) <br />' Obtain Site Address 911 Address Sign <br />'Obtain Building Permit Mobile Permanent Foundation Pennk <br />'Obtain Septic Permit 'Mobile Temporary Foundation Permit <br />" Obtain Access Perrn~ 'Obtain Floodptain Pemtft <br />' Subdivision of Property 'Other <br />" Request to be considered for Exemption from Local Road eurldirxi Requirement <br />' Request for Change in Zoning District PD FPD <br />'Request for Variance from Aorass Policy <br />' Request for Special Use Permit t/ <br />~ o,, ` J1 / <br />Signature ridovvrt ..Appirc nt..or authorized agent (Please circle) Date <br />torms/quesl Mar 1997 <br />