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iL) <br /> REZONE PETITION # (.03ZT- CONDITIONAL USE PERMIT # <br /> C.U.P. ONLY: Action i is - ot requested at the <br /> Public Hearing . <br /> r. t- <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 /> No FLOOD PLAIN <br /> No WETLANDS <br /> --/6S SHORELAND - Body of Water 1 e 4-1-Q u L <br /> 4--v-; 6 'y Lod ; 1---C <br /> Ho WELLHEAD PROTECTION AREA Quo, p <br /> 1-40 DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> r,_ D HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> y_es e rleiuo <br /> I.2-- r p copy <br />