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( o <br /> REZONE PETITION # 69431 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 /> No FLOOD PLAIN <br /> pp WETLANDS <br /> pa SHORELAND - Body of Water <br /> ND° WELLHEAD PROTECTION AREA <br /> No DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> :)o HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> -16-5 0 .E D • <br /> • E5 co. . tit�wro <br /> F. P . COPY <br /> L• p . ✓ <br /> ✓ NtAP ✓ O <br />