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LAND USE INTENT APPLICATION <br /> TOWN OF VERMONT <br /> . <br /> SECTION A (To be completed by Current Owner) <br /> Name r' <br /> t Property Description: <br /> Address 7 / i. ,-/it:.- 1, 7 <br /> Sec. <br /> Phone_(�o 8 7 7 z 6 <br /> Acres 7 (' <br /> I currently own acres allowing for <br /> potential lot(s) according to <br /> the Town of Vermont Land Use Plan adopted 2/11/8 . <br /> If this petition is approved, I will own CJ 5 <br /> retaining potential lot(s). acres, <br /> The applicant will be entitled to create ;' <br /> residential lot (s). <br /> Other provisions: <br /> Z <br /> JEIZ <br /> Z'. <br /> ****************** /`1ti..t,�i.a-1,,i ,S� <br /> SECTION B (To be completed by A `Y ***** <br /> f -17 Le <br /> Action Requested (check as appropriate <br /> k. Zoning change from , , <br /> Conditional Use Pern <br /> �� yes. <br /> Ordinance Variance 'd C 1 <br /> Other r �_' �`i� <br /> Describe intended use: v <br /> (' ( ti ,, <br /> .t>c -..> <br /> �� . <br /> 1 S i �,�„( ts I^ <br /> `r, <br /> Required Documentation: <br /> r►.. <br /> 1. Site Pl an showing: <br /> f�t <br /> g: <br /> existing and proposed structures boundary dimensions <br /> _.sewerage system site <br /> existing and proposed roadbeds tillable land <br /> wooded areas <br /> slope and drainage <br /> 2. Approval **Sewerage System A <br /> g Y <br /> documentation from Dane 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 />