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. I 1 I Z8 <br /> REZONE PETITION # (p370 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 /> No FLOOD PLAIN <br /> oo WETLANDS <br /> po SHORELAND - Body of Water <br /> ov WELLHEAD PROTECTION AREA <br /> 00 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 17. E. <br /> yE> Go . ME�c0 <br /> �S r� COPY <br />