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Name
of
Plumber
PLUMBING PERMIT - Oshkosh, Wisconsin Permit N!'? 667
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I Block . I Ward
l~œNo,
I Addition or Replat
Date
OUTSIDE WORK
NIW SEwn WATER STORMS FEES FEES RElAY S. SEWER WATER STORMS FEES
From MaIn to Curb Seplic Tanks From Main to Curb
nom Curb to BuDding Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
NEW
FEES
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USEO
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NO.
NEW
REP. I USE.
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NEW
RE,.
USE.
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Garbage Diapon]o
Catch BulDs
_Tub
Diahwuhen
Conduclors
Wuh Buin
Water Cl_t
Laundramats
Grease Catch Bulns
Sump Pump" Ejeelors
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Water Softeners
Sink
Sanitary Bubblers
Water Heate..
Bar and Soda Wales
,ov
1/ Qþ
Urinals
Shower Baths
Floor Drains
Dental Cuspidors
Laundry Tube
Service Sinks
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---------------------------------------------------------Inside
Valualion 01 the Work Herein Described
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Fee Verified. Receipled and Recorded
Received Permit and Inspection Feeo
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nJ¡J,_t.t7P.m_Total
Date ¿:;¡ /."" /...
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In the peHormance of this work the undersigned owner (or his authorlzad agent) of sold premises and his authorized Plumber hereby agree tri be1íounden 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 the undersigned that no other uses will be made of the above connections
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