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" PLUMBZ:N PERMIT - Oshkosh, Wisconsin
Name .' - ,,' ~-\ Sireel
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Permi! N~ 1750
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¡ Lol No.
r:Ck I Ward
I Addition or Replat
Data
OUTSIDE WORK
NEW ,Ewn WATE. STORM' FEE' FEE' .ELAY ,. 'EWE. WATE. STORM' "E'
From Me1D to Curb Seplic Tenks From Main 10 Curb
From Curb to BuUdIn" Electric Pumps From Curb 10 BuUding
Repair
INSIDE WORK
NO. NEW UP. U'ED "ES NO. NEW .EP. U'EO FEE' NO. NEW .EP- USED FEES
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Bath Tub Garbage Dispooals Catch Basins
-
Wash Basin Dishwashen Conductors
I~ - - - -
Water CI_t Laundramats Grease Catch Basins
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.L Sink / Water Softeners Sump Pump" Ejeclors
Water Heatars Sanilary Bubblers Bar and Soda Wastes
Show.. Batha UriDaIa
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F1oor DraIDs Denial Cuspidors 1.- I~
- -
Laundry TubtI Service Sinks
InapadiOIUl jValuation of the Work Hereio Described Fee Verified, Receipled and Recorded Received Permi! and Inspecllon Fees
-;:;;¿E=::=::=:::::::¿fP¡b.C;Z::: $--:st2-__Z--_h_h______hh---___------__h'___---- ---_--____hhhhhh-Sewer Fees
J ---¿---0::9--nhh_PIbg. Fees
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In tho performance of this work the undersigned owner (or his authorired agent) of said premises and his authorized Plumber hereby sgree to be boundan by and
submit to ell statutes, city ordina s, and rule. and regulations prescribed by the Board of Public Works for the government of Plumbers.
rsigned that no other usos will be made of the above connections except as heralnaftor. listed.
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STATE OF WISCONSIN)
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WINNEBAGO COUNTY)
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being first duly sworn on oath deposes and says that he is not
a licensed plumber, and that he has applied for a plumbing
permit to the Plumbing Inspector of the City of Oshkosh, to do
plumbing work in a home owned and occupied by him, or a home
that is being constructed that is owned by him, and which will
be occupied by him as his home when completed, That he is not
building said home for the purpose of sale.
This affidavit is made for the purpose of complying with
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may be done by one who owns and occupies his own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin,
This affiant understands that the Plumbing work authorized
by the permit applied for, must be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work. '
Dated this
..e7..2- day 0 f ~ ' --------- , 1 9 7¿
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Subscribed and sworn to before me
this rd21l d,.~:.Of .~-'~ ' _19?f__,_-
Notary ~qi~~~~b~9O County, Wisconsin
-IdXOOMMISSION
My Commission Expires:--_~ElV~~~---