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REZONE PETITION # G 5-y(PCONDITIONAL 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 /> et TOTAL A�EES 1 ✓� I o � � -mo o f c c 1_10 FLOOD PLAIN 0-7-1„ <br /> � ; (4 . ) <br /> 1.40 WETLANDS <br /> 1.40 SHORELAND - Body of Water <br /> p_,o WELLHEAD PROTECTION AREA <br /> Nc) DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> po HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s) ; list <br /> pertinent information and questions . <br /> yeS <br /> aX E - - <br /> y FS F p LaaY <br /> MAP i D <br />