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PLUMBING PERMIT - Oshkosh, Wisconsin Permit NI? 9121
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l Lot No.
I Block I Ward
l-- Addition or Replal
------
Dale
OUTSIDE WORK
NSW SEwn WAIn STORMS ms "ES 'E'AY S. SEWE' WATE' STORMS FEES
From MaIn to CU1'b Septic Tanks From Main to Curb
From CU1'b 10 Building Electric Pumps From CU1'b to BuUding
Repair
INSIDE WORK
NO- NEW ..,. USID FRES NO. NEW 'EP- USEO FEES NO. NEW 'EP. USEO 'EES
- - -
Bath Tub Garbage DIs~ 1- Calch Bulns
-
Wuh Buin Dlshwuhers 1- Conductors
- -
Walar CIONt Laundramals I Greue Calch Bulns
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SIDk Water Softeners -- Sump Pump" Ejectors
Water Heaters Sanitary Bubblers Bar and Soda Wutes
Shower Baths Urinals ~
Floor Drains Dental Cuspidors 1- 1-
- -
Laundry Tuba Service Sinks
I...pections Valuation of the Work Herein Described Fee Verified. Receipted and Recorded Received Permit and Inspection Fees
---------------------------------------___-----Oulside $-- --LYQ__:_QQ------------------------------------- ----------------------------Sewer Fees
--------------------------------------------------------Inside -----l_~--<!=....._----_Plbg. Fees
:::::::z~~¡:==::::::::::;~~; $--------------------------------------------------------------------------- ---_J,-Q:Q------Total
$------------------------------------------------------------------------ ----------------------ëi;:;-T;;;;;~;;;-------------------------- Date 3/31 (7b
In the performance of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by ond
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 made of the above connections except as hereinaltor listed-
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