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i0:,. _-,,,t Dane County Planning & Development <br /> -,� 1, ... ' Room 116, City County Building, Madison, Wisconsin 53709 Land Division Review <br /> ..,i_ 1 ID �� 608/266-9086 <br /> �'` .`„ "6= Property Listing <br /> 608/266-4120 <br /> Surveyor <br /> 608/266-4252 <br /> CERTIFICATION OF OFFICIALLY MAPPED AREAS Zoning <br /> 608/266-4266 <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 '27 day of -? , 20 in Madison Wisconsin. <br /> i <br /> Signed: Adaiigia <br /> Witness: <br /> Zoning Permit# <br /> h:\plandev\zoning\znr\forms.fmt\officially mapped areas.doc (Revised 03/00) <br />