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Dane County Planning & Development <br />City -County Building, Madison, Wisconsin 53709 <br />Planning <br />Room 116,603,266-4251 <br />Zoning <br />Room 116,608P-66-4266 <br />CERTIFICATION OF OFFICLALLY KkPPED AREAS TO Community Development <br />APPLICANT'S LANDS Room 421, 6081261-9781 <br />Records & Support <br />Room 116,6081266-4251 <br />The undersigned applicant for a zoning permit under Chapter 10 of the Dane County <br />Ordinances thus certifies as follows: <br />I. 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. § 1 D.25 (6)(b) and (d) Dane County Zoning Ordinance) <br />Dated this day of1X141 2001, at Madison, Wisconsin. <br />Signed: � /,2 4 <br />Witness: <br />Zoning Permit # <br />FORMSLIB:CERT MAPPED AREAS APPLI'S LAND (1212003) <br />