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Wisconsin De-partment 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 /> SEEINSTRUCTIONS ON BACK OF YELLOW COPY- programs[privacy Law,s 1504(l)(M)I, <br /> The information you provide maybe used by other government agency pr <br /> P MAPPLICANT . ... <br /> ER.P.:.fTRrstName Middle initial <br /> Last Name <br /> res , Ile) --I.,os <br /> Street Address <br /> /-/ Telephone No earea code), <br /> City <br /> State Zip Code <br /> q <br /> )ECT LOCATION <br /> Subdivision Name L # Block # <br /> Building Address I Tollander Acres <br /> Parte No 7 <br /> Lega Description 1/4 1/4, Section 23 T 40 N, R 16W E or W 20-9400-01-700 <br /> EQUIPMENT <br /> VAC <br /> 1 PROJECT TYPE 2 PROJECT H <br /> 1 Fa r mily ffForcedAir Urnace E] Radiant Baseboard or Panel (Elec.) [J HeatPump <br /> F1 2 Family ❑ Boiler E] Central AC E] Other: Solar <br /> 1 jq.�PKOJECT ENERGY SOURCE Nat.Gas L.P. Oil Elect. Solid <br /> Space Heating 11 0 0 11 <br /> Water Heating El El <br /> OC.PROJECr CONSTRUCTIO PROJ IN <br /> PE 51 PROJ <br /> E] Site C I onstructed E] Concrete Masonry ❑ Treated Wood <br /> Manufactured ❑ Other(specify): <br /> 8. PROJECT AREA '7 ESTIMATED PROJECT BUILDING COST <br /> livin area 1: 11:1Feet $ <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. <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. Irealize <br /> Date Signed <br /> Applicant's-Signature <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSU 9 ING PURISDICTION. ff] Town E] Village El City 0 County of: Oakland <br /> Where Dwellin FEES: None <br /> MUNICIPALITY NUMBER: 0 7 - 0 2 _(located <br /> PERMIT ISSUED BY: Burnett County Zoning DATE ISSUED'. 10/17/95 <br /> W6 Egg iL <br /> SBDB 8254(R 09J94) White-Issuing Jurisdiction Pink-DILHIR Within 30 Days Yellow-Applicant <br />