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Wisconsin Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Labora6d 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 /> U 'X� <br /> PERM PUA� 'A <br /> 1,cs <br /> Last Name First Name Middle Initial <br /> �C\ <br /> v\d 5a es R <br /> Street Address <br /> (3 <br /> City State Zip Code Telephone No.(include area code) <br /> 5-50 1 � � U - ISO <br /> cl 7 r-\ ,P- nts' VA V\ <br /> ............. <br /> *K0:K <br /> �Mx <br /> Q� <br /> M'M :Xxx <br /> -A <br /> Building Address Subdivision Name Lot# Block# <br /> ls�o Lr,5c,,, Le-f_ UJ's Sd8S3 Big Yellow Lake Estates 15 <br /> Legal Description Parcel No. <br /> 1/4, 114, Section T 40 N, R 16W E or W 20-9170-02-500 <br /> 7. N I <br /> ICE TAPE N <br /> .... ...... <br /> 'X ........... <br /> 0 1 Family 0 Forced"Air ltrn ce E] Radiant Baseboard or Panel M.ec. Heat Pump <br /> ❑ 2 Family E] Boiler ❑ Central AC 0 Other: <br /> .. ........ <br /> P OJ ORGY SQU Nat. Gas L.P. Oil Elect- Solid Solar <br /> Space Heating El 0 0 11 0 13 <br /> Water Heating 1:1 El 0 0 Q 1:1 <br /> ,K <br /> 41�: <br /> x .. S L T <br /> Ty. F Ho 'S PRIJCFOIJAIAATEI <br /> M Site Constructed E Concrete 0 Masonry Treated Wood <br /> 0 Manufactured 0 Other: <br /> ..........:................. <br /> ECARE <br /> IT <br /> Xy 7"o X. <br /> Livina area It �14_aq,81) Square feet S <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 permit does not relieve me of compliance with other applicable codes and ordinances. <br /> 5- is- 13 <br /> Appli(,a)nt's Signature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> _0............ ................ <br /> I.S$VING. Town ❑ Village ❑ City ❑ County of: Oakland <br /> 'N�I'll <br /> Where <br /> Mlj Ig.., <br /> N <br /> I: C'IPALITY'� JMOER4.1:4 0 7 - 0 2 0 Located DwellinNone <br /> PERM ISSIJEtJ BY: <br /> Zoning Office DATE ISSUEI?: <br /> SBD-8254(R_02/90) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />