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REZONE PETITION # (,lcrw 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 /> WETLANDS <br /> SHORELAND - Body of Water <br /> _c,-/ WELLHEAD PROTECTION AREA <br /> 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 /> e t-i ti <br />