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REZONE PETITION # (.,Z31 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 /> fY b cti t �t O L•1 ei �c ci e e <br /> 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 /> 15 3 i+-ct % +-x 3 on -A' c2 —2/ s o X71 /1, <br /> O -f �_. p,�v� c S e d (Sl-( <br />