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Z5 <br /> REZONE PETITION # L.410 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 /> P l A 2T FLOOD PLAIN a c S o c i ►-e d i 5 „` ■ / <br /> CU. v.J ✓ 0 c. (7Ar� PI <br /> N o WETLANDS r <br /> PA 2T SHORELAND - Body of Water I k e ,,A ;t} cis., ,-- <br /> oo WELLHEAD PROTECTION AREA C✓e e ckpr.-cx ' ty <br /> 5 N * F <br /> ► o DANE COUNTY REGIONAL AIRPORT HEIGHT pa. -ctc . <br /> LIMITATION AREA <br /> o HISTORIC OVERLAY DISTRICT (Indian Burial <br /> Mounds) <br /> COMMENT: Describe location of affected area (s ) ; list <br /> pertinent information and questions . <br /> 1-10 p .E ,D • <br /> e c. M -e wt o <br /> I�IO FP Copy <br />