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*Z3 <br /> REZONE PETITION # ` 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 area is of <br /> of <br /> proposed Rezone/C .U . P . a a <br /> the districts below: <br /> 0, FLOOD PLAIN <br /> 00 WETLANDS <br /> Po SHORELAND - Body of Water <br /> pc) WELLHEAD PROTECTION AREA <br /> DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT : Describe location of affected area ( s) ; list <br /> pertinent information and questions . <br /> yes p. a .°. <br /> co. <br /> ��S FP c-oPy <br />