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PLUMBING PERMIT - Oshkosh, Wisconsin Permit Nr: 8485
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I Lot No. I Block Lv.rard __I_~~ion_or Repla! .
Dale
OUTSIDE WORK
NEW SEWEll WAIn STORMS "'S FE" .ELAY S. SEW" WATE' STORMS FEES
From MaiD to Curb Seplic Tanks From Main 10 Curb
From C...b So BuUcIbIg Eleciric Pumpe From Curb 10 Building
Repair
INSIDE WORK
NO. NEW UP. USED "ES NO. NEW .EP. USE. ,,"S NO. NEW .EP. USE. FEES
- -
Bath Tub Garbage Diopooa1s Ce.ieh Bum
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Wub Basin Dishwashers Couduci.rs
- - - - -
WaI8r Clooot Laundr8D1ÚS Grease Catch Buina
Sink I Water Softe"ers Sump Pump I!I: Ejeclors
Waler Heaters Sanilary Bubblers Bar and Soda Wasles
Shower .Batha Urinals
n""" Draina Denial Cuspidors
Laundry Tubs Service Sinks I
IIIIpec!iolll Valuation of Ihe Work Herein Described Fee VerUled. Receipled and Recorded Received Permi! and Inspection Fees
-_.--- .--.-.------ ----_..-- Outside $ _..L22.~..~_.__.---------- -------------.------. -.------------------Sewer Fees
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$-.--------------------------------------------------- ___--l'_:~_- Tola!
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------FbIa1 OK: $-------------------..-------------------- Date ?(.,;LJ 7..$
In the performance of this work the undersigned owner (or his authori.ed agent) of said premi..s and his authorized Plumber hereby agree to be bounden by and
submit to all statutes, city ordinances, and rules and regulations prescribed by Ihe Board of Public Works for the g~vernmenl 01 Plumbers.
It Is fulher agreed by Ihe undersigned that no other uses will be made of the ebove connections except a. hereinaller listed.
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