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Permit # <br /> Wisconsin 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. See instructions on back of yellow copy. <br /> ............ <br /> APPLICANT <br /> M <br /> Last Name First Name Middle Initial <br /> -4 <br /> Street Address <br /> City_ state Zip Code Telephone No.(include cirea code) <br /> PitOJEz z N <br /> ........ ... <br /> CT PCA ON <br /> ........... <br /> Building Address Subdivision Name Lot# Block # <br /> _)5 daon &D(;,--N <br /> Legal Description Parcel No. <br /> NW _1/4, NE 1/4, Section 8 T 4Q N, R 16W E or W 20-4308-01-200 <br /> 7, PROTECT .......... <br /> TYPE 1PROtECTHVACEQUIPMENT <br /> .. .......... <br /> ....................... <br /> 1 Family JK Forced Air Furnace LJ Radiant Baseboard or Panel(Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler [I Central AC ❑ Other: <br /> 3* PROTECT ENERGYSOITRCE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 0 19 El 1:1 11 C1 <br /> Water HeatinEl <br /> : L_ ". ........ . <br /> 1 .. <br /> ...... <br /> EEE <br /> X,RROJfCTX9NS7Cr 00 ! PCi . PROJoa:F, UND: ON 'o <br /> Site Constructed ❑ Concrete masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other: <br /> 6.'PROTECT AREA 7. ESTtMATEDPROTECTBITII RIttIC,77777777777777777='L <br /> ST, <br /> L <br /> Li vi nq area = C) Souare Feet S 6, <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 /> Aorpli nt'sSignature Date Signe <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING <br /> :JURISDICTION:' <br /> 0 Town E] Village [I City of: Oakland <br /> M UN ICIPALITY NUM BE R* # <br /> __Q-- -----7- - ___Q_ 2 n None <br /> PERMIT IS$( BY <br /> Zoning Office <br /> SBD 8254 IN 09/89) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />