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45 <br /> REZONE PETITION # (o4Z� CONDITIONAL USE PERMIT # <br /> C.U.P. ONLY: Action is/is not requested at the <br /> Public Hearing. <br /> Date <br /> Place an "X" in the box if all or part of the <br /> proposed Rezone/C. U. P. area is affected by any of <br /> the districts below: <br /> po FLOOD PLAIN <br /> Po WETLANDS <br /> No SHORELAND - Body of Water <br /> Qo WELLHEAD PROTECTION AREA <br /> 00 DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> PO HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> D. E- D . <br /> r. 2. CoPy <br /> L.o. ✓ � <br /> MAP ✓ • <br />