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3 <br /> REZONE PETITION # (03oZ 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 /> ►.�o FLOOD PLAIN <br /> 00 WETLANDS <br /> Poss L-- <br /> Y 6.2,_ SHORELAND - Body of Water t ; s a <br /> P- (7_,-e <br /> I-)o WELLHEAD PROTECTION AREA Q y b <br /> iii+k∎ 00 ci1 lt� <br /> 00 DANE COUNTY REGIONAL AIRPORT HEIGHT Cc' -"- -- ° P - <br /> LIMI TATION AREA <br /> p° e d. r-e3 d <br /> orQo , <br /> PQ HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> YES � E <br /> Rea` d FP <br />