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PLUMBING PERMIT - Oshkosh, Wisconsin
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I Lol Ho. I Block I Ward
OUTSIDE WORK
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Permit N<! 9441
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I Addition or ReplBl
Date
NEW SEWEI WATER STORMS lEES FEES RELAY S- SEWER WATER STORMS FEES
From MaIn to Curb Septic Tanks From MaiD to Curb
""'m Curb 10 BuUdlng Electric Pumps From Curb to Building
Repair
INSIDE WORK
110-
NEW
RIP-
flU
NEW
REP- I USED
NO.
NEW
lEES
REP.
USED
lEES
USED
NO.
Bath Tub
Garbage DiIpoIa1a
Dlshwuhers
Catch BuÙII
Wash Buin
ConductO"
Water CIOI8t
LaundrlUDato
Gre... Catch BBIÙII
I-
SIIIk
/
Water Sofiene..
Sump Pump II: Ejectors
t!-<ìO
Water Heaten
Sanitary Bubblers
Bar and Soda Wutes
Shower BathR
Urinals
Floor DraIDa
Dental Cuspidors
Laundry Tube
Service Sinks
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Va~ion of the Work Herein Described
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Fee Verified. Receipted and Recorded
Received Permit and Inspeclion F...
~-------------_---Sewer Fees
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--'>9/'..:..--12Þ._---Total
Date ~?/'!J ¿;;Ç
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---------------------Final OK
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In the performlnce of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by and
lubmlt 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 us.. will be made of the above connections except as hereinafter listed.
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\Address I
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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 ng Inspector of the City of Oshkosh, to do
plumbing work in a ;,ome owned and occupied by him, or a home
that is being constructed that is owned ~y 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 provision;; of th" plumbing code of the City of Oshkosh and
the State of Visconsin, which p;ovides that all plumbing wo~k
must be done by a licensed plumber except that the plumbing work
may be done by one vho owns and occupies his own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of W~con9in.
STATE OF WISCONSIN)
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WINNEBAGO COUNTY
This ~ffi3nt understands that the Plumbing work authorized
by the permitëippJ.i,,"d for, must be done only by this affiant and
that he can"1ot emplo" others who are not licensed plumbers .to
assist wi th the work,
Dated this ó?.i.,..- day of ~----~--~-, 19_¿(.
~_o
Subscribed and sworn to before me
daY~', -- -', 19,2&.
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bIg, Win7O89 unty, .Wisconsin
My Commission Expires:~~.~~~:J-L:--~