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AFFIDAVIT �?ELATING TO SECTION 13.12 (c ) OF A GENERAL OADINANCE
OF THE CITY OF OSFiKOSH AELATING TO THE LICENSING OF ELECTBICIANS
AND PAOVIDING PENALTIES `
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STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
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!� / �'L�� .C.��S O , � �5 Q �i% c.L /I/� '
Name � Address °
,
first being duly sworn on oath, deposes and says that he is not
a ]�icensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a �
residence and/or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is owned and occupied '
by him, or is bein� constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by `
the permit applied for in connection with this affidavit, must g
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
Dated this � day of �.�,� , 19�•
,
U�� r�:
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Subscribed and sworn to bef e �
� thi s '' �
� , o �/Lu , 19�,�-�
. f.�v'
Notary Public, Winnebago County, Wisconsin
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