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PLUMBING PERMIT - APPLICATION AND RECORD
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:åwri¿r IJÈ'À7DE"Bft..LRYNO
Cré'aY; Date" 68ì3Õ/2005'
Bathtub ' 0 ' Shower
, Whirlpool 0 'Floor Drain
La:--atory" ~ LndrY Tray'
Toilet" 0 Dísposal
R';s, Sink ~ Dishwasher
Bar Sink ~ Sump Pump
Water Heater --1 ClassrnfS,ink
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Ejê¿tór/Grind
0
0
, 0
0
" 0
Õ
0
0'
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'càtJ~ó\r;i ~ 11'" R~~id~ntial-W~ter Heáters 'píá~
Watê;:~~ff~ë;' 0 Wãiì.s{ ---.2.~"¿tlarii'p;s~ñ~L:- Õ'Co~eeMáfer
Local Wast,,' 0 Ice Chest ~ FlrlWsí Sink ~ Int Grease Trap ~
Clothes Wshi' ,. 0' Exam Sink '~Catch Basin '~' ' ExfGieàse Trap ~
Bidet '0 Sculry Sink 0 Wash Ftn" 0 'RPZ Valve 0
- -
Beer Tap 0 'Hand Sink o' Urinal 0' Eýe Wash Statn 0
- -
LaD Sink' ".0 ' 'Plàstér Sink ~ .StaÌ1dp Rèc '~ Wti Sewer Mtiš' ~'
Sterilizer '~' Surgeons Sink'~ Ice Maker ~ Deduct Meters' 0
lìipWell' "'õ FPiõpSink 0 Gar'Drain 0 Wir'usageMtrS' '0
- -
Drink Ftn 0 Serv Sink 0 Soda Disp 0
Contractor jbHN D'RANSOM
Size
Material
Type
#
Conn. Type
0
0
0
0
0
Parcelld #
1312260000
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement holder(s) and to secure any necessary approvals before starting such activity,
Signature
Date
AgenUOwner
Address W5056 PARADISE LN FOND DU LAC WI 54935 - 0000 Telephone Number 920-922-1987
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection'(i.e. Footing, Service, Final, etc.), Access into Building if Secùre (how do we gain eritry),'yóur Name and Phone
'Number. Unless specified otherwise, we will assume the projeCt'is ready at the timè the "iequest is reCeived. Work may
.. cóntinu'1. ift~e inspection is not performed within two business days from the time the project is ready.