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REZONE PETITION # (,4 4o 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 /> pater <br /> APtd.0 FLOOD PLAIN A <br /> WETLANDS <br /> ?AZT SHORELAND - Body of Water <br /> r b(it-�-'"Q ✓ 1-0 S Cl CA LA- <br /> 0 WELLHEAD PROTECTION AREA Grt e ✓c-4 S w E. a 0 e a t'' <br /> ,,) o 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 /> DIES D. E .c� . <br /> Co . EXEC . P-lEti-co <br /> i <br /> qa ✓ O <br />