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-21 <br /> REZONE PETITION # ('3� l 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 /> N v FLOOD PLAIN <br /> 140 WETLANDS <br /> 1-to SHORELAND - Body of Water <br /> I-4o WELLHEAD PROTECTION AREA <br /> iA o DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> No HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s) ; list <br /> pertinent information and questions . <br /> '(es <br /> (0P7 <br />