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dt / / <br /> REZONE PETITION # (o4o5 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 /> t.3o FLOOD PLAIN <br /> pp WETLANDS <br /> pc) SHORELAND - Body of Water <br /> 1,.)o WELLHEAD PROTECTION AREA <br /> ,- D 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 /> yts . E .D . <br /> _ <br /> . P <br /> FP 6P/ <br />