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�6° rti Dane County Planning & Development Zoning <br /> ,J Room 116, City-County Building, Madison Wisconsin 53709 608-266-4266/608-267-1540-Fax <br /> OM� - <br /> CERTIFICATION OF OFFICIALLY MAPPED AREAS TO APPLICANT'S LANDS <br /> The undersigned applicant for a zoning permit under Chapter 10 of the Dane County Ordinances thus certifies <br /> as follows: <br /> 1. That he or she has made diligent inquiry into the applicability of any official map to the applicant's land. <br /> 2. That no such official map is applicable or, if such map is applicable, the approval of the appropriate city <br /> or village has been obtained. <br /> 3. That the applicant has not relied upon any statements of County employees in giving these assurances. <br /> 4. That the applicant understands the possible adverse consequences of erecting any structure within an <br /> officially mapped area without the proper approval of the city or village involved. Any zoning permit <br /> issued for a property located within an officially mapped area for which the applicant has not obtained <br /> the proper permit from the appropriate village or city shall be null and void. (Ref. §10.25 (6)(b) and (d) <br /> Dane County Zoning Ordinance) <br /> Dated this/9day of /.1. , 19/cat Madison, Wisconsin. <br /> •/ �i� <br /> ,"i�, <br /> Signe,. ��� _�I/.1�1_►` <br /> Witness: <br /> Zoning Permit# <br /> FORMSLIB:CERT MAPPED AREAS APPLI'S LAND (3/98) <br />