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REZONE PETITION # - CONDITIONAL USE PERMIT # ) ; io <br /> C.U.P. ONLY: Action is/#112oVreguested at the <br /> 1-115 194, 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 /> Kp o FLOOD PLAIN <br /> 00 WETLANDS <br /> po SHORELAND - Body of Water <br /> 1.40 WELLHEAD PROTECTION AREA <br /> 1_10 DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> too HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> Nom C-ct . P IZZS <br /> !-to p. ED . <br /> _g `I° <br /> co . `X - - r�EfriD <br /> 1,10 F Lo •Y <br /> L• � <br /> D . <br /> p <br />