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..._.e-tor‘:.:er <br /> '� ) Dane County Planning & Development <br /> \ i Room 116, City-County Building, Madison, Wisconsin 53709 Land Division Review <br /> �sCo 4- 608%266-9086 <br /> •-"'—� Property Listing <br /> 608/266-4120 <br /> Surveyor <br /> 608/266-4252 <br /> Zoning <br /> CERTIFICATION OF OFFICIALLY MAPPED AREAS TO APPLICANT'S LANDS 608/266-4266 <br /> The undersigned applicant for a zoning permit under Chapter 10 of the Dane County Ordinances thus <br /> 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 these <br /> assurances. <br /> 4. That the applicant understands the possible adverse consequences of erecting any structure <br /> within an officially mapped area without the proper approval of the city or village involved <br /> Any zoning permit issued for a property located within an officially mapped area for which <br /> the applicant has not obtained the proper permit from the appropriate village or city chnil be <br /> mill and void. (Ref §10.25(6)(b)and(d)Dane County Zoning Ordinance) <br /> Dated this day of ----- (/� ' ,19 CPI,at Madison,Wisconsin. <br /> Signed: ( L1j; <br /> �ivsW <br /> Witness: <br /> Zoning Permit#: >�17 ' 3i Z� <br /> FORMSLIB:CERT MAPPED AREAS APPLI'S LAND(3/98) <br /> L., <br />