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REZONE PETITION # (,,q oiCONDITIONAL 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 /> 100 FLOOD PLAIN <br /> too WETLANDS <br /> oo SHORELAND - Body of Water <br /> f,30 WELLHEAD PROTECTION AREA <br /> �0 DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> 00 HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area ( s ) ; list <br /> pertinent information and questions . <br /> YES a. <br /> PS Co . Exec 1--1Pwep <br /> 1�10 FP L'oj'y <br />