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Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <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 PLY <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(i)(m)] <br /> ­11 WHE NEW <br /> Ta- <br /> r... .t. ,,,: .:< <br /> Last Name First Name Middle Initial <br /> Ckiric h SJU�, <br /> Street Address <br /> a 6 <br /> City State Zip Code Telephone No. (Include area code) <br /> o U_%- M 5 51 5 6 51--73o 16111 <br /> Building Address Subdivision Name Lott/# Block# <br /> Lo-1 % `Jeer tc- V;e-,J Lo-"e- 5ur,r'%Sa Be-"D / <br /> Legal Description Parcel No. <br /> I Y 0 1/4, N 0 1/4, Section A T _aa--N, R I E or® Q Q 0 0 0 U <br /> i / <br /> ® 1 Family ® Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Famil ❑ Boiler ❑ Central AC ❑ Other: <br /> Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ N ❑ ❑ ❑ ❑ <br /> Water <br /> :.� Heating ❑ ❑r0 ❑ <br /> .dK ., n� / <br /> X <br /> .. <br /> . ti <br /> ® Site Constructed ❑ Concrete ® Masonry ❑ Treated Wood <br /> ❑ Manufactured(to the WI UDC, not U.S.HUD code) ❑ Other s ectf Ble`ic <br /> .. , ° •.;•� n,�»» ,.•�, » .;, Y,,J' ,.� ».,.. , ..,, Ott'.. it » '`"'�y'. <br /> i <br /> Living area= 1900 Square Feet $ -70) 600 :5 e.lt <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 /> _ I Lahti . ,, 10-15-01 <br /> Applicant's Signature Date Si ed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> MIITown ❑Village ❑ City ❑ County of: <br /> _ Q d <br /> SBD-8254 (R.2/0l1) Distribution:0Ply 1-Issuing Jurisdiction ❑Ply 2-Municipality Forwards to State If New Dwelling ❑Ply 3-Applicant <br /> ISSUING JURISDICTION <br />