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. # 13 <br /> REZONE PETITION # (5to 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 /> pp FLOOD PLAIN <br /> 1-10 WETLANDS <br /> yes SHORELAND - Body of Water <br /> -{ ✓; ►� a}-u ' +b S a.- 2; J e <br /> ►moo WELLHEAD PROTECTION AREA -Cto,.-)5 5L4 L3E -i-11-1 <br /> I-40 DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> 00 HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> '—c c . r' .a. • <br /> y,- S e-h-t0 <br /> F 5 FP CO PY <br /> L . o . <br /> AP ✓ <br />