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i � \\11 <br /> • .; Dane County Planning & Development <br /> '., c_gektii. , % City-County Building, Madison, Wisconsin 53709 <br /> , ♦ as , r <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 /> APPLICANT'S LANDS Room 421,608261-9781 <br /> Records&Support <br /> Room 116,608/266-4251 <br /> e undersigned applicant for a zoning permit under Chapter 10 of the Dane County <br /> Or ' ces thus certifies as follows: <br /> 1. That he or she has made diligent inquiry into the applicability of any official map to the <br /> applican 's land. <br /> 2. That no such official map is applicable or,if such map is applicable,the approval of the <br /> appropria e city or village has been obtained. <br /> 3. I .t the applicant has not relied upon any statements of County employees in giving <br /> these ass . ces. <br /> 4. at the applicant understands the possible adverse consequences of erecting any <br /> structure 'thin 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 th applicant has not obtained the proper permit from the appropriate village or city shall <br /> be null . 1 d void. (Ref. §10.25 (6)(b)and(d)Dane County Zoning Ordinance) <br /> Dated this al day of he r I / 20 D M,at Madison,Wisconsin. <br /> c,......._ <br /> Signed: Ask, . <br /> Witness: <br /> Zoning Permit# <br /> FORMSLIB:CERT MAPPED AREAS APPLI'S LAND(12/2003) <br />