HomeMy WebLinkAbout0000247 P
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Name
of
PIUJDber
~/77 I I I I
Data / Lot No. Block Ward Addition or Replat
OUTSIDE WORK
NEW SEWEll WAtER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn to Curb Septic Tanks From Main to Curb
FMm Curb to BuDding Electric Pumps From Curb to Building
Repair
INSIDE WORK
110.
NEW
UP.
NO.
NEW
FEES
REP. I USED
FEES
NO.
NEW
REP.
USED
USED
FEES
-,-
Batb Tub
Garbage Disposals
Dishweshers
Catch Bum.
Wuh Besm
Conductors
Water CI_t
¡/
¡
I--
bo
1/.0t)
Gre... Catch Besm.
Laundramals
Sbs1o:
Water Softeners
_1
Sump Pump" Ejectors
v
Wa!ar Haatan
Sanitary Bubblers
Bar and Soda Westes
J
1/
t,O(.!
UriDaIs
Shower Baths
noor Dr8hu
Dental Culpidors
Laundry Tubs
~~:~~=::=:::=~~:=:::::==::::::();:~:
Service Sinks
Fee Verified. Receipted and Recorded
Valuation of the Work Herein Delcribed
Received PermU and Inlpectlon Fees
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--_..<f.~..Q.(;¿_. Total
Date ¿;,--hj 7 '7
$------/Z.&.__--~_iP..zL______------
$-
0
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-----.-.t:1..L...~---Finai OK
In the p\,rMrrl.el.ce of this work the undo...lgned owner (or his authorized agent) of said premises and his authorized Plumber hereby agr:e to/be bounden by ..,d
submit to all statutes. city ordinances. and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It Is futher agreed by the undersigned that no other uses will be mede of the above connections except as hereinafter listed.
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STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY)
-1. ~~.!~~.-.::c)--~_-flç?~!,5;!.'-, __--1L5 6_-,&J_dTD ~ ---
\Name \Address
being first duly sworn on oath deposes and says that he is not
a licensed plumber and that he has applied for a plumbing
permit to the Inspector of the City of Oshkosh, to do
plumbini::¡ work in a ;-,ome owned and occupied by him, or a home
that is being constructed that is owned by him, and which will
be occupied by him as his heme when completed. That he is not
building said hcme for the pu~pose of sale.
This affidavit is made for the purpose of complying with
the provisions of the plumbing code of the City of Oshkosh and
the State cf Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may be done by ont) vho owns and occupie$ his own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the Btate of W~consin.
This affiant understands that the Plumbing work authorized
by the permit appJ.ied for. must be done only by this affiant and
that he can~'ot employ others who are not licensed plumbers to
assist with the work,
M,' <hi, K- d'y of ~, 192;2.
~.~d~~
Subscribed and sworn to before me
this day o~~~-~-, 19~~.
. .lzLf~~____-----
No ry Pu lie, Winnebago County, Wis.c::msin ."
.fè'o~;;';;SSION EX?iBŒ
My Commission Expires;_____-~~~Jb~2L~_-