HomeMy WebLinkAbout0008211-Plumbing (lavatory)
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PLUMBING PERMIT - Oshkosh, Wisconsin Permit N~) 8211
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I L_ot_No,____- I Block I Ward I Addilion or Replai
Date
OUTSIDE WORK
NEW SEWEll WATEII STORMS FEES "'S RELAY S. SEWE. WATER STORMS fEES
From Mam to Curb Septic Tanks From Main to Curb
!'10m ClUb to BulIcUnll Electric Pumps From Curb to BuiIc1ing
Repair
INSIDE WORK
NO. NEW AlP. USED "ES NO. NEW .,.. USED I~ NO. N'W REP. USED 'EES
- - -
Bath Tub Garba¡¡o Diaposals Ctdch Bu¡""
- -
Wuh Bum / r,"6 Diahwuhors Conductors
- - - -
Wat... CloMt Laund>:ema.tI ar- Catch Baaiw1
SIDII: Water Softeners Sump Pump 8< Ejectors
Water Hoaters Sanitary Bubblers Bar and SocIa Wastes
Show... Baths Urhsa1s
Floor ÐraIDa Dental Cuspidors
Launclry Tubs Service Sinks
Inopec:tions Val7n of ~he Work Herein Described Fee Verified, Receiptec1 and Recorded Received Permit anc1 Inspection Foes
- ----------------- ------- Outsicle 7f.: (}{J ,,;¡:--.-------m------.sewer Foes
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--- --- --.-..------------InsicIe ~_J2L'L__Plhø' Fees
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-___------!'hsal OK $---------------------------------------- Date ~- I- 7~
In the performance of this work the undersigned owner (or hi. authorired agent) of .aid preml.e. and his authorized Plumber hereby agree to be bounden by ...d
submit to all slatutes, 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 except a. hereinalter listed.
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PlumbIng In",..."
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STATE OF WISCONSIN
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, WINNEBAGO COU]\J"TY
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, (Name)
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(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 Plumbing Inspector of the City of Oshkosh, to do
plumbing work in a home 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 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 of Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may be done by one who owns and occupies his own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin.
, This affiant understands that the Plumbing ,~rk 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 this ~ day of tl
. 19 '7 r~
Subscribed and sworn to before me
"" ---L...- doy of ~' 19 75":
0 f;uo~ . X'-//~
Notar~blic, Winnebag~Ounty, Wisconsin
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My Commission Expires:
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