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REZONE PETITION # (,0S5 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 /> 144.e) -To-c'AL. 4c.e-S <br /> No FLOOD PLAIN <br /> ,_Ao WETLANDS <br /> N 0 SHORELAND - Body of Water <br /> ,Jd WELLHEAD PROTECTION AREA <br /> ,,, a DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> ,tea HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> YaS Cam E. D . <br /> Go . EXEC . MEM? <br /> YF S_ F p Lar=.Y <br /> ✓ L. � • '� ' D <br /> L/ MAP p <br />