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110303 <br /> Wisconsin De'partmi!ntof 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 maybe used by other government agency programs(Privacy Law,s. 15 04(1)(m)I. <br /> PERMIT APPLICANT <br /> Last Name First Name Middle Initial <br /> �•9�! t j AJuJn <br /> Street Address _ <br /> /5- ��- <br /> cit State Zip Code Telephone No.(include area code) <br /> ;q,19 /i lvIeLd �l/� SSSS `� SOS s3,r- -7 L) 36 <br /> PROJECT LOCATION <br /> Building Address ` Subdivision Name Lot# Block # <br /> Fla DIwe CSM V.13 P.252 5 <br /> Lega Description Parcel No. <br /> Gov 't Lot 4 & 5 <br /> 1/4, 1/4, Section 35 T 41 N, R 16W E or w 32-5335-02-610 <br /> 1. PROJECT TYPE 2. PROJECT HVAC EQUIPMENT <br /> amily [E.Forced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boilerentral AC ❑ Other: <br /> 3. PROJECT':ENERGY SOURCE Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ 0-�' ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ ❑ <br /> 4. PROJECT CONSTRUCTION.TYPE S. PROJECTFOUNDAMON'. <br /> rte Constructed [J.26ncrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6. PROJECT'AREA: <br /> ' 7. ESTIMATED PROJECT.BUII DtNG'COST <br /> Livin area = /HOD Square Feet $ 9J 000 <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 issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> 3L <br /> AWicantXSignature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION: Town ❑ village ❑ City ❑ County of: <br /> Swiss <br /> Where <br /> MUNICIPALITY NUMBER: # 0 7 O 3 2 Located <br /> welling FEES: <br /> None <br /> PERMIT ISSUED BY: Burnett County Zoning Office i DATE ISSUED. 14/29/96 <br /> SBDB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />