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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 /> .......... .. ... <br /> Last Name First Name Middle Initial <br /> A <br /> '�5e'e_66 <br /> Street Address <br /> q2 4 <br /> City State Zip Code Telephone No.(include area code) <br /> Building Address Subdivision Name Lot# Block# <br /> Z& A; Parcel No. <br /> Legal Description Gov't. Lot 4 <br /> —1/4, 114, Section 35 T an N, R 1(,W E or W 20-4335-02-100 <br /> tIVAc EgtJiPMI NT <br /> 1 Family Forced Air Furnace E] Radiant Baseboard or Panel e (El ec.) ❑ Heat Pump <br /> E] 2 Family 10 Boiler C] Central AC E] Other: <br /> 3. PRaJECTENERGYS0tJRGE <br /> Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 0 0 Cl El 0 <br /> Water Heating 0 <br /> :N ...... <br /> . PRf?JECTfNSTRLJt31+t TYPE 5.. <br /> M, <br /> AR[fJECT F!?q <br /> n: <br /> ... ..... <br /> . ........-i. .... <br /> Site Constructed El Concrete Masonry ❑ Treated Wood <br /> E] Manufactured El Other: <br /> ............ .......... <br /> ............ <br /> NORO. <br /> A 0.... <br /> "ED: <br /> x"c <br /> Square Feet <br /> Livingarea - 4�: <br /> I present tWat all the above information is correct, a4uniderstand 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 I-and 2-family dwellings and must be complied with. Irealize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> gzi�e:1)�w4p� _311-�; /,?--/ <br /> _�7pplicanf s Signature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> M Town ❑ Village E] City C] County of: Oakland <br /> Where Dwelling <br /> M:UNICIP ITY NV. # 0 7 - 0 2 0 Loci None <br /> I <br /> PERM-TAUIRD <br /> S -8:Y Zoning Aw UECls Z ng Office 3/15/94 <br /> SB D-82 54(R.02190) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />