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PLUMBING PERMIT - Oshkosh, Wisconsin Permit N'? 115
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I Block I Ward
OUTSIDE WORK
I Lot No.
I Addüion or Replat
Date
NEW SEwn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaID to C...b Seplic Tanks From Main to Curb
........ C...b to BuDding Electric Pumps From C...b to Building
Repair
INSIDE WORK
NO.
NEW
"P.
NEW
FEES
REP. I USED
FEES
NO.
NEW
REP.
USED
USED
flES
NO.
Batb Tub
Garbage Dl8pooa1s
Catch Bulna
Wub Buln
Dishwuhen
Conductor.
Wat- CI_t
Laundr-
Gre... Catch Buina
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SIDk
Water Softeners
Sump Pump Ik Ejectors
Water Heaters
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sanUary Bubblers
Bar and Soda Wute.
Show- Baths
Urinals
F1ooz DraIDs
Laundry TubI
Dental Cuspidors
I~-
Service Sinks
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V;atlon of the Work Herein Described
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Fee VerUied. Receipted and Recorded
Received Permit and In.pectlon Fees
............................Sewer Fees
.:~~::::::: Fee.
Date .z6/A:/
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In the performance of this work the undersigned owner (or his authorized agent) of .eid premise. and hi. authorized Plumber hereby egree to be bounden by end
submit to all .tatute., city ordlnence., and rule. end regulations prescribed by the Board of Public Works for the goyernment 01 Plumbers.
It I. luther egreed by the undersigned that no other use. will be made 01 the aboye connections except as hereineller listed.
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