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G PÉRMIT - Oshkosh, Wisconsin "perm¡ì N~ 1025
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I Lot No.
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b I Ward
OUTSIDE WORK
I Addili.on or Replat
Date
NEW SEwn WAtER STORMS fEES FE" 'ELAY S. SEWE. WATE' STORMS FEES
From MaIn 10 C...b Septic Tanks From Main 10 Curb
FRom C...b 10 Building Electric Pumps From C...b 10 Building
Repair
INSIDE WORK
110.
NEW
REP.
NEW
'EP. I USE.
NEW
FEES
fEES
NO.
REP.
USE.
USED
"ES
NO.
BathTub
¡
/
/
LaundrlUDlWl
Grease Catch Basins
Garbage Diopooala
Catch Bu1Ds
¡/J'O
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II. v-C
Wuh Basin
Diohwashen
Conduelo..
Watar CIONI
SIIIk
Water Softeners
Sump Pump" Ejeclo..
Water Heale..
Sanilary Bubble..
Bar and Soda Wasles
Shower BaIhs
UriDats
noor Dra1sul
Denial Cuspldon
LeUDdry Tubo
Service Sinks
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Valuation 01 Ihe Work Herein Described
$ ......~r?..CE.'h..~.m..~--:Q--hh""----"-
0
Fee Verified. Receipled and Recorded
Received Permit and Inspecllon Fees
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City T.."""
In the performanca of Ihi. work Ihe undersigned owner (or hi. aulhorized agent) of .aid premise. and hi. authorized Plumber hereby agree t.rbe bounden by and
submit 10 all .tatutes, city ordinances, and rul.. and regulations pre.cribed by Ihe Board of Public Works for the government of Plumbers.
It Is luther agreed by Ihe undersigned that no olher uses will be made 01 the ebove connections excepl as hereinalter listed.
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WINNEBAGO COUNTY
STATE OF WISCONSIN)
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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 Plu~bing Inspector of the City of Oshkosh, to do
plumbing wcrk in a home owned and occupied by him, or a home
that is being constructed that is owned by him, and which wiU
be occupieci 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
mðy be done by one ~ho 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 unc!c:r:òtands that the Plumbing work authori¡:ed
by the permit applied for, must be done only by thi$ affiant and
that he ca!",..,o"~: f!i":plQ'1 others who are not licensed plumbers to
"'i'~,:~;"::: ~ d,y of -~~
Subscribed and sworn to before me
thi, J:3j;,£ d" of ~'9.2L '
Not'T; P"bïl~"nt~=rn .
MY COMMI§§!U! eXPIRE!
My CommissionExpi;res :------~:'::':~:...:?E!..~__-