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STATE OF WISCONSIN )
WINNEBAGO COUNTy � SS
)
_/ ' �OI E'/..Zd/fJ► ,c/ `' /�
(Name). � /J� �f'"` �
(Address
being first duly �worn on oath deposes and says that he is n�-�
a 1lcensed plumber, and that he has applied for a plumbinq
permit to the Plumbing Inspector of the City of Oshkosh, to d,:;
plumbing work in a home owned and occupied by him, or a home
that is being constructed that is owned by him, and which u=iZ�
be occupied by him as his home when completed. That he is nat
building said home for the purpose of sale.
.
This affidavit is made for the
.
the provisions of the plumbing code ofrPheeCitycofpOshkoshi��ad
the State of wisconsin, which provides that all plumbing wo�k
must be done by a licensed plumber except that the plumbinq ��c�!-
may be done by one who owns and occupies his own home pro�idir.�
the installation complies with the plumbing code of the City o� `
Oshkosh and the State of Wisconsin.
Thi� affiant understands that the Plumbing work authorize�=�
by the permit applied for, must be done only by this affiant an�?
that he cannot employ others who are not licensed plumbers to
assist with the work.
Dat ed this � da y o f �/�,1�,�,G,� 19 �l ,
.
--_--_
�,/�-� G�
Cl
Subscribed and sworn to before me
a�� � R
�his day of � �Li� , 19 U�
.
i
_ :
Notary pu lic, innebago County, Wisconsin
�. .� � �P��!':�I^j�^�`I r"'..q-;�'�� -
' My Commis s ion Expi res � ,4jF 4 ; ;,