City of Whitewater Landmarks 312 W. Whitewater St. Whitewater, WI 53190 262-473-0144
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Local Landmark Designation Nomination Form
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1. Name
Historic____________________________________________________________________________________
and/or common_____________________________________________________________________________
2. Location
street & number____________________________________________________________________________
city, town_________________________________________congressional district____________________
state_________________________ zip code________________ county _____________________________
3. Classification
Category Ownership Status Present Use
____district ____ public ____occupied ____ agriculture ____ museum
____building(s) ____private ____unoccupied ____ commercial ____park
____structure ____both ____work in progress ____ educational ____private residence
____site Public Acquisition Accessible ____ entertainment ____religious
____object ____in process ____yes: restricted ____ government ____scientific
____being considered ____yes: unrestricted ____ industrial ____transportation
____no ____ military ____other:
4. Owner of Property
Name_______________________________________________________________________________________
street & number_____________________________________________________________________________
city, town______________________ vicinity of_________________ state_________________ zip_________
5. Location of Legal Description (In County Courthouse)
courthouse, registry of deeds, etc.___________________________________________________________
street & number_____________________________________________________________________________
city, town__________________________________________________ state____________________________
6. Representation in Existing Surveys
Title_________________________________________________________________________________________
Date__________________________ ____federal ____state ____county ____local
depository for survey records ________________________________________________________________
city, town___________________________________________________ state___________________________
7. Description
Condition Check One Check one
____excellent ____deteriorated ____unaltered ____original site
____good ____ruins ____altered ____moved (if so, date moved ___________________)
Describe the present and original (if known) physical appearance_____________________________________________
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8. Significance (Continue on separate sheets if necessary)
Period Areas of Significance-Check and justify below
____prehistoric ____archeology-prehistoric ____community planning ____landscape architecture ____religion
____1400-1499 ____archeology-historic ____conservation ____ law ____science
____1500-1599 ____agriculture ____economics ____literature ____sculpture
____1600-1699 ____architecture ____education ____military ____social/
____1700-1799 ____art ____engineering ____music humanitarian
____1800-1899 ____commerce ____exploration/settlement ____philosophy ____theater
____1900- ____communications ____industry ____politics/government ____transportation
____invention ____other (specify)
Specific dates______________________________ Builder/Architect___________________________________________________
Statement of Significance
(Give specific sources for all statements of fact.)
9. Major Bibliographical References
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10. Geographical Data
Acreage of nominated property _________________________
Quadrangle name ________________________________________ Quadrangle scale _______________________________
UMT References
(Optional)
Zone Easting Northing Zone Easting Northing
A __________________________________________________ B __________________________________________________
C __________________________________________________ D __________________________________________________
E __________________________________________________ F __________________________________________________
G __________________________________________________ H __________________________________________________
Verbal boundary description and justification __________________________________________________________________
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11. Form Prepared By
name/title ________________________________________________________________________________________________________
organization__________________________________________________________________date_______________________________
street & number________________________________________________________ telephone______________________________
city or town__________________________________________________________________state_______________________________
12. Municipal Data
Zoning District: ______________________ Aldermanic District: _____________________
Parcel Number: ________________________________________________________________
Commission Actions
Hearing Approved: ____________________ Hearing Date Set: _______________________
Landmark Designated (Date): ___________________ Number: ________________________
Certified By: ___________________________________________________________________
Commission Chairman
Date: _________________________________________________________________________