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/fiO <br /> REZONE PETITION # (0. 55 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 /> FLOOD PLAIN <br /> 00 WETLANDS <br /> 1,30 SHORELAND - Body of Water <br /> o WELLHEAD PROTECTION AREA <br /> loo DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> po HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area ( s) ; list <br /> pertinent information and questions . <br /> Na D . E . � <br /> Co. EXEC . MEt.40 <br /> ( e; C o Fr-,1 <br />