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Wiscorisin 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)]. <br /> PI:RMET APPLICANT <br /> LasttNNa476A.? <br /> First Name Middle Initial <br /> 1 atria <br /> Street Address <br /> City State Zip Code Telephone No (include area code) <br /> .R.O.MC�r LOCATION <br /> Building Address Subdivision Name Lot# Block# <br /> Tollander Acres 2 <br /> Legal Description Parcel No. <br /> 1/4, 1/4, Section 23 T 40 N, R 16W E or w 20-9400-01-200 <br /> 9,;PROJECT TYRE 2. ;PROJECT N. fA EQUTAMEAIT: <br /> 1 Family Forced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> B ': PROJECT ENERGYSOURCE << Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ (�' ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> 4., PROJECT C�7IVI'STRUCTION TYPE 5. PROAJ I"+D, iAt lO tl <br /> XSite Constructed ❑ Concrete j$ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> &. PROJEIGT AREA . I«S7WATE'R PROJECT BUILDIM: Q T,., . <br /> /0M &U <br /> Livingarea = /OM Ag4l S uareFeet $ 77 9TY <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 iante of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> pplicant s ignature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISI)ICTIOf�t: ® Town ❑ Village ❑ City ❑ County of: Oakland <br /> where Dwelling <br /> MUNICIPALITY NUMBER' 0 7 - 0 2 0 Located EE!ES. ! None <br /> PERMIT ISSUED,BY: Burnett County Zoning DATE ISSUED' 7/10/96 <br /> SBDB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />