HomeMy WebLinkAbout2013-Plumbing (cross connection control) qTY OF OSHKOSH INSPECTION SERVICES DIVISION ROOM 205 ��,���"Ep �
275 CHURCH AVE DEPARTMENT OF COMMUNITY DEVELOPMENT
POBox1i30 CORREGTION NOTIGE
�2�� OSHKOSH
OSHKOSH WI 54903-1130 tJk�t� ON THE WATER
Issue�ate 1 2/1 81201 3 Re Issue Date Complies No
Address 1770 W MURDOCKAVE
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Sent to ✓ Owner '��.. CENTURY OAKS HOMES lLC 2748 HOIIPAY CT NEENAH WI 54956 -9011
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introduction The"Permit to Operate"for the cross connection control assembly or assembiies registered to this address has expired.
Item# 1 Code SPS 38222(8)@}Lc Complies No Comply 8y 01/17/2014
Descriptio� An anuual perfoma�ce test shall be conducted for ali cross eonnection control assemblies.
Summary You are required to have your assembly or assemblies tested within the neut 30 days by a certified Cross Connection Control
tester. The resulis must be submitted to the State and the local municipality. Failure to comply with these instructions will
result in further action up to disconnection of your water service.
Violations must be corrected and approved by the noted compliance dates of each item. Cali for reinspections prior to concealment
andior occupancy. Upon completing the corrections,the ownerlcontractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of 7117/2014
Office hours are Monday through Friday 7:30 a.m. -4:30 p.m.or by appointment.To schedule inspections please call the Inspection
Request lin at 36- 128 noting ihe address,permit number(when applicable),and the nature of what needs to be inspected.
SignatureGf��������� Date ��,.'''f�i''(..�
Inspected by: Jon Mueiler 236-5049 jmueller@ci.oshkosh.wi.us
i hereby certify the violations listed on this report have been corrected in compiiance with the appiicabie codes.
Print Name Company
Signature Date �
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