HomeMy WebLinkAbout0000692 P
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I Lot No. I Block I Ward I Addition or Repl&!
OUTSIDE WORK
Date
NEW SEwn WATER STORMS fEES FEIS RElAY S. SEWER WATER stORMS FEES
From MaIn 10 Curb Seplic Tenks From Main 10 Curb
From Curb 10 BuUcllng Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
NEW
UP.
REP. I USED
....
fEES
NO.
USID
FlES
NO.
NEW
NEW
REP.
USED
BaIb Tub
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Catch BulDo
/,ðO
Garbage Dispooals
Wub BuiD
Dishwuhers
Conduciors
Water CI_I
Laundramals
Greue Catch BulDs
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¡/
I
;'"CJ
Water Softeners
Sump Pump" Ejeclors
Sink
Water Heaters
Sanitary Bubblers
Bar end Soda Wules
Shower Baths
UriDaIa
Floor Dr8lu
Denial Cuspidors
Laundry Tubs
Service Sinks
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Received Permit end Inspecllon Fees
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._.2'--<?~-----.---.PIbg. Fees
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Fee Verified, Receipled end Recorded
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In the performance of this work the undersigned owner (or his suthorired agent) of $Oid premises and his authorized Plumber hereby agt.e to"'e 'bóÚnden by and
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It is futher agreed by !he undersigned thet no other uses will be made of the above connections except as hereinafter listed.
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STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY)
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\Name! cr-------- ~ \~~~
being first duly sworn on oath deposes and says that he is not
a licensed plurnb'é'r, and that he has applied for a plumbing
permit to the Plu~bing Inspector of the City of Oshkosh, to do
plumbing wc.rk in a ;'ome owned and occupied by him, or a home
that is being constructed that is owned by him, and which will
be occupieÔ by him9s 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 cf V"isoorsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may 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 \Vis consin.
This 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
thi, .,;/k-- d,y of ~------1!' 19 7f'
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Subsoribed and sworn to before me
this r;ltót!
-
Notary Pubîiç,
My Commission Expires :.1:::':...----------------