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• • # Z1 <br /> REZONE PETITION # (,5 4 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 /> -ro;4L. A�eES <br /> KW FLOOD PLAIN <br /> Q o WETLANDS <br /> No SHORELAND - Body of Water <br /> 1,,0 WELLHEAD PROTECTION AREA <br /> -o DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> oo HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area ( s ) ; list <br /> pertinent information and questions . <br /> yes o. e . o . rz- t ot-)Ly <br /> E i c.-o. EX EG . h-t c r-t0 <br /> F <br /> L. L . ✓ • D <br /> �-- MAP `/ 1 <br />