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& I �''- Dane County Planning & Development <br /> WL.Ri'lCity-County Building, Madison, Wisconsin 53709 <br /> ra <br /> Planning <br /> Room 116,608/266-4251 <br /> Zoning <br /> Room 116,608/266-4266 <br /> CERTIFICATION OF OFFICIALLY MAPPED AREAS TO Community Development <br /> Room 421,6081261-9781 <br /> APPLICANT'S LANDS <br /> Records &Support <br /> Room 116,608/266-4251 <br /> The undersigned applicant for a zoning permit under Chapter 10 of the Dane County <br /> Ordinances thus certifies as follows: <br /> 1. That he or she has made diligent inquiry into the applicability of any official map to the <br /> applicant's land. <br /> 2. That no such official map is applicable or,if such map is applicable,the approval of the <br /> appropriate city or village has been obtained. <br /> 3. That the applicant has not relied upon any statements of County employees in giving <br /> these assurances. <br /> 4. That the applicant understands the possible adverse consequences of erecting any <br /> structure within an officially mapped area without the proper approval of the city or village <br /> involved. Any zoning permit issued for a property located within an officially mapped area for <br /> which the applicant has not obtained the proper permit from the appropriate village or city shall <br /> be null and void. (Ref. §10.25 (6)(b) and (d)Dane County Zoning Ordinance) <br /> Dated this ¢ day of At9 V. 20 ,, at Madison,Wisconsin. <br /> Signed: _ <br /> Witness: <br /> Zoning Permit# <br /> FORMSLIB:CERT MAPPED AREAS APPLI'S LAND (12/2003) <br />