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REZONE PETITION # (p4(4 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 /> i- o FLOOD PLAIN <br /> No WETLANDS <br /> i-ao SHORELAND - Body of Water <br /> No WELLHEAD PROTECTION AREA <br /> HD DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> No HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s) ; list <br /> pertinent information and questions . <br /> yes <br /> cam . lea, EXEc . ,Liv <br /> N2� Fp. CcP`/ <br /> .D ✓ ' D <br />