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PLUMBING PERMIT - Oshkosh, Wisconsin Permit N? 8934
-¡-. Name 1/ Street
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I Lol No. '" Block I Ward I Addition or Replat
OUTSIDE WORK
Date
NEW SEwn WATER STORMS 'EES 'EES RElAY S. SEWER WATER STORMS FEES
From MaID to Curb Seplic Tanks From Main 10 Curb
!'10m Curb 110 Bullcllnsr Eleclric Pumps From Curb to Buüð.ing
Repair
INSIDE WORK
NO. NEW RIP. US... "ES NO. NEW RoP. USED "'S NO. NEW REP. USED FEES
Bath Tub L j,(J{ Garbage Diapooals C&Ich Buiwl
Wuh Buin / ~ j,(J( DishwMhers Conduclors
~ ~ - - -
Wat.. <::I_t Jf Laundramals Gre..... ClOtch BMiwI
SIIIk .. ~. Water Softeners Sump Pump 11< EI.cIOtS
Water Heate.. fl / /;0\; Sanitazy Bubblers Bar and Soda Wasl...
Shower Baths UrÙlÙS
Fl- Dralrul Denial Cuspidors
LeW1dry Tubs Servi<:e Sinks
I~ns V*~ati~n of Ihe Work Herein Described Fee Verified. Receipled and Recorded Received Permit and Inspection Fees
--------------- ---Outside $-...7"i.U-:-_!!5?----------------------..-..-----. -----..-------------..--Sewer Fees
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$-.......-----..------------------------------..---------- D~~-/7!}/Zal
---------------FiDaI OK $-------------..-------....-----------------..------ --------------"---------c¡iÿ-ir.ãw;.;------"--""------
In Ihe perfermance of Ihis work Ihe undersigned owner (or his aulhorized agent) of said premises and his aulherized Plumbar hereby agree 10 be bounden by and
submillo all slalules, city ordinancas. and rul.. and regulalions prescribed by Ihe Board of Public Works for Ihe governmenl of Plumbers.
II Is fulher a9""", by Ihe undersigned Ihal no olher uses will be made of Ihe above connections exc~pl os hereinoller listed.
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Plumb«
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