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CERTIFICATION OF OFFICIALLY MAPPED AREAS <br /> TO APPLICANT'S LANDS <br /> The undersigned applicant for a zoning permit under Chapter 10 of the Dane <br /> County Ordinances thus certifies as follows: <br /> 1. That he or she has made diligent inquiry into the applicability of any official <br /> map to the applicant's land. <br /> 2. 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 /> 3. That the applicant has not relied upon any statements of County employees in <br /> giving these assurances. <br /> 4. 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 /> Dated this (0 day of PA) <br /> t= , 200 , in Madison Wisconsin. <br /> Signed: <br /> Witness: <br /> Zoning Permit# O " y9 C <br /> h:\plandev\zoning\znr\forms.fmt\officially mapped areas.doc (Revised 03/00) <br />