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REZONE PETITION # (p3'52- 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 /> oo FLOOD PLAIN <br /> ,,Do WETLANDS <br /> Po5 s SHORELAND - Body of Water I p e P e,d <br /> q cs-.,� d✓a .�.a.� f - <br /> IJO WELLHEAD PROTECTION AREA � P c <br /> r ut 5 (!0.s �-- - ,) e s av� <br /> N v DANE COUNTY REGIONAL AIRPORT HEIGHT °P r o s e s d i °F <br /> LIMITATION AREA 200.d <br /> (-•3 ;-1-L-6 LA Soo & c <br /> ;o c HISTORIC OVERLAY DISTRICT (Indian Burial ;' P ° d !. <br /> Mounds) <br /> COMMENT: Describe location of affected area (s) ; list <br /> pertinent information and questions . <br /> YI DES <br /> YES C-C) E-XEL. fri 0 <br /> �� FP CoP'/ <br />