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Permit #20223 <br /> Wisconsin Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Labor and Human Relations BUILDING PERMIT APPLICATION <br /> (Wis.Stats. 101.63(7)& 101.65(3)) <br /> Submit to non-enforcing municipalities for new 1-and 2-family dwellings. <br /> SEE INSTRUCTIONS ON BACK OF YELLOW COPY. <br /> The information you provide may be used by other government agency programs[Privacy Law,S. 15-04(1)(m)I- <br /> PERM lT APPI ICANT <br /> Last Name First Name Middle Initial <br /> V t4^ YR-0 ki J, <br /> Street <br /> ^�Address �Jc �Zyry�� <br /> �}J ✓�7(D� I - 1 1 IF <br /> City <br /> State Zip Code Telephone No.(include area code) <br /> Sfi _ � l Mn , ssi � 777rl <br /> �'Irt,�CA' N <br /> Building Address <br /> Subdivision Name Lot# Block # <br /> CSM V.6 P.36 2 <br /> Parcel N0. <br /> Legal Description Gov't Lot 4 <br /> 13 T 39 N R 14W F or w 24-3113-04-600 <br /> 1/4, 1/4, Section <br /> 7 PRQ1IwC f TYRE 4i PRt73EGT HVAC EQUIPMI«NT <br /> ®'1 Family ❑ forced Air Furnace Radiant Baseboard or Panel (Floc.) ❑ Heat Pump <br /> E] 2 Family ❑ Boiler E] Central AC ❑ Other: <br /> % <br /> PRQJ CT ENERGY SOURCE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ® 0 <br /> Water Heating El ❑ El El <br /> + PRQ1C"i CONSTRUCTION TYPE S. PRCfJECT I"tl'UNI3TIQN <br /> Site Constructed �'Concrete EJMasonry El Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6. PROJECT AF EA 7. .E T#MATEDP€it3lEc7i tsv . :, to:: < <br /> Living area = yy S uare Feet $ <br /> I present that all the above information is correct, and understand that the issuance of this permit is for <br /> administrative purposes only. Onsite construction inspections will not and shall not be performed by the <br /> municipality which has not assumed jurisdiction per s. 101.65, Wis. Stats. I understand the Uniform Dwelling <br /> Code, Chapters ILHR 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. I realize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> Applic nt'sSignature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> 1S$UINp,jURISDIa.1ON' [1� Town ❑ Village ❑ City ❑ County of: Rusk <br /> Where DwellingI»E <br /> MUNICIPALITY NUMBER' 0 7 0 2 4Located NONE <br /> PERMIT ISSUED BY: Burnett County Zoning Office DATE ISSLIEQ. 4/21/97 <br /> SBDB 8254(R 09194) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />