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. * 4 <br /> REZONE PETITION # (..p56 ( 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 /> -T o 1'A t.... A c.e.E S <br /> 1,10 FLOOD PLAIN <br /> 1,40 WETLANDS <br /> SHORELAND - Body of Water <br /> WELLHEAD PROTECTION AREA <br /> „Do DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> Q0 HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> NO p. E. D • <br /> om Go . EXEC • ME.fri <br /> 1,1 R. F p Lo.PY <br /> 1..`A P ✓ D <br />