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#z5 <br /> REZONE PETITION # (P ,o) 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 /> Ac-e.ES <br /> 00 FLOOD PLAIN <br /> ,uc, WETLANDS <br /> SHORELAND - Body of Water <br /> ,N0 WELLHEAD PROTECTION AREA <br /> ,Q0 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 /> \/E5 cam. . D . <br /> NIES <br /> NO F <br /> C) ✓ D <br /> • <br /> ,/� MAP ✓ C) <br />