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PLUMBING PERMIT - Oshkosh, Wisconsin Permil N~ 9115
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I Block I Ward
OUTSIDE WORK
Date
I Lot No.
I Addilion or Replat
NEW SEWn WATER STORM. FEE. FEE. RELAY S. .EWER WATER STORMS FEE.
From MaIn 10 Curb Seplic Tanks From Main 10 Curb
From Curb 10 BuIlcllng Eleclric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
NEW
RE'.
USID
FlES I NO.
NEW
FEE.
NEW
FEES
RE,.
USED
R". I USED
flO.
BB!b Tub
Garbage Disposals
CII!cb BaslDs
1-
Wub Basin
Dlsbwasben
Conduclon
Waler Cloaat
Laundramll!s
~
:fr'M
l-J/ ,ðÒ
Gre... Catch BaslDs
Sink
Water Softenen
Sump Pump II< Ejeclors
/
Water Heaters
~
sanUary Bubblers
Bar and Soda Wasles
~.oo
Shower BII!hs
Urinals
1-
Floor DraIDa
d
Denial Cuspidors
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Laundry Tub<
l...pacIions
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Serrice Sinks
Va~ion of Ihe Work Herein Described
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.
Fee Verified. Receipled and Recorded
Received Permit and Inspection Fe..
.... ..................80wer Fees
:1'i~:~::::::::::; Fees
Date Jbmc:
.....m.-.---...-..----Final OX
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In the performance of thi. work the undersigned owner (or his authorized agent) of said premises and hi. authorirad Plumber hereby agree to be bounden by and
submit to all .tatutes. city ordinances. and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It is futher agreed by tha undersigned that no other uses will be made of the aboVl connections except as hereinafter listed.
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rs.LETE
Pittsville Homes, Inc.
Bo. C - Hwy, BO South. P';t"vill.. WIs<onsln 54466
Phon. (715) 884.2511
MANUFACTURER'S OF THE BEST IN MODULAR HOMES
PLUMBING AFFIDAVIT
STATE OF WISCONSIN
COUNTY OF WOOD:
PITTSVILLE HOMES, INC. of Hiw~ 80 South, Pittsvi11e, Wisconsin,
b,e,ing duly swom',on oath, state~,tha"t the above f,loor P1umb,1,'ng work
, '~'
in modular home purchased by '. ~ /¿ I
and being delivered to: . Street Address! :;;~j.J/
;t5d~A4.Á: ~/~~/
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City
State
has been tested and installed in comp1ianoe with the Wisoonsin State
Board of Health Plumbing Code.
sibi1ity of local plumber.
Subscribed and sworn to before
"', . ,
11.¡¡-t.,c H-
this )3
dq of
All underf100r connections are respon-
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fi ;:{j~, M~~¥d
me
19ìfo..
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Notary Public
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Wisoonsin
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Coun1iY
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