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REZONE PETITION # 64/5 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 /> Q0 FLOOD PLAIN <br /> �0 WETLANDS <br /> io SHORELAND - Body of Water <br /> ,-4 o WELLHEAD PROTECTION AREA <br /> do 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 /> I�Jo D- -D <br /> C o r,•i <br /> C, . ✓ D <br /> c-4 A i' i) <br />