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1 ; „I Dane County Planning & Development <br /> -,∎ E I F! Room 116, City-County Building, Madison, Wisconsin 53709 Land Division Review <br /> \ti,'��3''t s�= 608/266-9086 <br /> !cos_____-- <br /> Property Listing <br /> 608/266-4120 <br /> Surveyor <br /> 608/266-4252 <br /> CERTIFICATION OF OFFICIALLY MAPPED AREAS Zoning <br /> TO APPLICANTS LANDS 60e/266-4266 <br /> r •dersigned applicant for a zoning permit under Chapter 10 of the Dane <br /> . . Ordinances thus certifies as follows: <br /> at he or she has made diligent inquiry into the applicability of any official <br /> p to the applicant's land. <br /> That no such official map is applicable or, if such map is applicable, the <br /> approval of the appropriate city or village has been obtained. <br /> That the applicant has not relied upon any statements of County employees in <br /> giving these assurances. <br /> That the applicant understands the possible adverse consequences of erecting <br /> any structure within an officially mapped area without the proper approval of <br /> the city or village involved. Any zoning permit issued for a property located <br /> within an officially mapped area for which the applicant has not obtained the <br /> proper permit from the appropriate village or city shall be null and void. <br /> (Ref. §10.25 (6)(b)and(d)Dane County Zoning Ordinance) <br /> K Dated this day of , u , 20 , in Madison Wisconsin. <br /> Signed: <br /> Witness: <br /> Zoning Permit# <br /> h:\plandev\zoning\znr\forms.fmt\officially mapped areas.doc (Revised 03/00) <br /> 0 <br />