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REZONE PETITION # CONDITIONAL USE PERMIT # r - t <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 /> ,moo FLOOD PLAIN <br /> WETLANDS -W ( LL 0EE3 D i t-C , 4,DATi0r'J <br /> SHORELAND - Body of Water <br /> r_ o WELLHEAD PROTECTION AREA <br /> r ; . 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 /> p. E. D . <br /> y'F GO EXEC . ME frt <br /> I"�J F P C_oC'Y <br /> ' D <br /> MAP ✓ ` � <br />