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Wisconsiri Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> LaLbror 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 /> .... ...... <br /> M <br /> M <br /> Last Name First Name Middle Initial <br /> 4 eC, &A itp <br /> Street Address <br /> 7 <br /> City State Zip Code Telephone No (include area code) <br /> AI <br /> a fs C IT, I / Z -7 ([Z (n 0 <br /> PRDIEGT Sx <br /> SLgGACiNx <br /> o. <br /> Building Address Subdivision Name Lot# Block# <br /> I River Oaks 17 <br /> Legal Description Parcel No. <br /> -1/4, 1/4, Section 7 T 40 N, R 16W E or W 20-9155-02-7010 <br /> .......... <br /> ... ........ <br /> 1 Family ❑ Forced Air FurnaceR:diantBaseboard or Panel (Elec.) 0 Heat Pump <br /> 2 Family ❑ Boiler E3 C ntralAC 0 Other: <br /> B. PROJECT Rq:Y, IRGE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating El 0 0 El El <br /> Water Heating ❑ 13 0 El ❑ <br /> ii'z ...... <br /> 4. <br /> % <br /> CT <br /> [?F Site Constructed 0 Concrete [N masonry E] Treated Wood <br /> F1 manufactured 0 Other: <br /> . .......... <br /> 6. PRQJIwC1AREA <br /> T <br /> Livin area = 00 Squ-r- Feet $ ��Zl <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. Irealize <br /> the issuance of this pit does not relieve me of compliance with other applicable codes and ordinances- <br /> -AP7 <br /> �Applicant's Signature Dat Sign <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING) RI501&10rc"R­'. Town E] Village ❑ City ❑ C <br /> ounty of: Oakland <br /> NIUWhere Dwelling <br /> 0 7 0 2 0 None <br /> N.11CIPALITY-NUMBER: :'# Located <br /> Zoning Office <br /> SBD-8254(R.02/90) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />