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Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsir <br /> municipalities for new 1- PERMIT APPLICATION Safety and Buildings Division <br /> and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) <br /> SEE INSTRUCTIONS ON BACK OF SECOND FLY <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)) <br /> 40 <br /> 7777777777 t�'PE y1j1 {LICrr <br /> Last Name First Name Middle Initial <br /> Lehman William & Jacqueline <br /> Street Address <br /> W .4612 Hwy "H" <br /> City State Zip Code Telephone No. (Include area code) <br /> Fond Du Lac WI 54935 920-926-0302 <br /> ---: wa3s ssR a'• >3m� „:,rua S 4' x ry, �*xa ', 1 °'? kx: M� i '. . r� <br /> ' <br /> r <br /> v <br /> � ... e k <br /> Building Address Subdivision Name Lot# Block# <br /> Red Fox Hideaway 9 <br /> Legal Description Parcel No. <br /> 1/4, 1/4, Section 13 T ±1--N, R 16 EorW 1032-9275-01 900 <br /> T: <br /> «,-PRO . ; r � `F. � . <br /> w <br /> aft 1 Family ;E� Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ❑ p <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> � <br /> ,. N�TR�CTIO�'' `:�'P��;{ '� � -P`•yX: ,." f x•lk'. E , s '�:�-,Y y, C4 x �y ro` .,r <br /> ',.�a� ,F«.. •`-« i �Vb lJl\L�1a a. � 'M.;o`:v-�s' � ,„' e+ :'z5$u��A� �.r <br /> �,, ,>„,, . ,. �. -- _.'.. - ¢';,gym - • .%„ `; <br /> ❑ Site Constructed Modular ® Concrete ❑ Masonry ❑ Treated Wood <br /> ® Manufactured to the WI UDC; not U.S. HUD code) ❑ Others ciOlt <br /> f ): <br /> 7.` STI1iTE� UILDING'COST <br /> Living ar#a`L'x30Square Feet 11329 $ 98, 500. <br /> I vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. I <br /> understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. I understand that the issuance of <br /> this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> 013 <br /> Applicant's Si ature- Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALrrY BEFORE FORWARDING PLY 2 TO THE STATE DMSION OF SAFETY AND BUILDINGS <br /> Town ❑ Village ❑ City ❑County of: <br /> ULI <br /> SBD-8254 (R.2/00) Distribution:❑Ply I-Issuing Jurisdiction ❑Ply 2-Municipality Forwards to State U New Dwelling ❑Ply 3-Applicant <br /> ISSUING JURISDICTION <br />