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i <br /> t <br /> REZONE PETITION # (oZCol CONDITIONAL USE PERMIT # <br /> P"- <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 /> oo FLOOD PLAIN <br /> No WETLANDS <br /> Ho SHORELAND - Body of Water <br /> ,,,0 WELLHEAD PROTECTION AREA <br /> 100 DANE COUNTY REGIONAL AIRPORT HEIGHT <br /> LIMITATION AREA <br /> eS <br /> p, s ,3c.e. HISTORIC OVERLAY DISTRICT (Indian Burial / / / <br /> Mounds) See ex4G-'U4 d '�� � 1S 30c- <br /> COMMENT: Describe location of affected area (s) ; list <br /> pertinent information and questions . <br /> a �xtt. 1`--t.ewt0 <br /> pei fP _Z-,1 C- e '. 1-- <br />