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I . . • <br /> LAND USE INTENT APPLICATION TOWN OF VERMONT <br /> • <br /> SECTION A (To be completed by Current Owner) <br /> Name >r- ; r.Y J v GY e✓ = : Property Description: <br /> • <br /> Address '-/// /7/17/ 1 :- 7 g /3 7 ,4 <br /> 7 Sec. <br /> Phone A 7/7 w .'/ Acres 2, 6 5 D <br /> I currently own %-> acres allowing for / potential lot(s) according to <br /> the Town of Vermont Land Use Plan adopted 2/11/85. <br /> If this petition is approved, I will own "-12- ' acres, <br /> retaining / potential lot(s). <br /> The applicant will be entitled to create %//f= residential lot (s). <br /> Other provisions: _ <br /> ***********************************************************'******* <br /> SECTION B (To be completed by Applicant) <br /> Action Requested (check as appropriate) /: . ,, : . <br /> X, Zoning change from // to �." '" for ,6SD acres. <br /> X Conditional Use Permit for te ,F 50 acres <br /> Ordinance Variance <br /> Other <br /> Describe intended use: <br /> /. l r i'? F ,0 ! /7- i / ! {r / KY?. `1 [ <br /> GI /• 5 <br /> v <br /> Required Documentation: <br /> 1. Site Plan showing: <br /> ...existing and proposed strt ctures _K boundary dimensions <br /> sewerage system site tillable land <br /> xexisting and proposed roadbeds wooded areas <br /> slope and drainage <br /> 2. Sewerage System Approva <br /> documentation from Dan County Environmental Health, signed by a . <br /> sanitarian showing that a conventional septic or mound system permit is <br /> available and has been approved for the proposed site. <br />