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AFFIDAVIT AELATING TO SECTION 13.12 (c ) OF A GENEAAL OHDINANCE
OF THE CITY OF OSHKOSA AELATING TO THE LICENSING OF ELECTHICIANS
AND PAOVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
;f r: � %T .< , �YEy , �'�S_" �!� /j".� �'�-�
Name Address
first being duly sworn on oath, deposes and says that he is not
a 1.icensed e7.ectrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or auxiliary bulldings (intended solely for pur-
poses associated with a residence) which is o�,med and occupied
by him, or is being 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
be done only by thls affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
family.
�'--
Dated this day of �;�L„�'-e� , i9z,
1- ��� �� _
Subscribed and sworn to before
thi s __�_ day of , <<"'�. , 19%�. � � �
��i,` �y,, ��� /, _/,
rlotary Public, Winnebago County, Wisconsin
My Commission Exp1res: � ` �,,; ' "���°N exn,`���
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