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PLUMBING PERMIT - Oshkosh, Wisconsin Permit N'.? 9423
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I Lot No. I Block I Ward - __1 Addition or Replat
OUTSIDE WORK
71
Date
NEW SEWD WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn fo Curb Septic Tank. From Main fo Curb
FNm Curb to BuDding d~6' r~ -f.PO Eleclric PumpR From Curb to Building
Repair
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INSIDE WORK
NO. NEW UP. USED FlES NO. NEW REP. USED FEES "0. NEW UP. USED 'EES
- -
Bath Tub Garbage Diapcoels Catch BasinR
- -
Wuh Buin Diabwuhen Conductoro
-
Water CIONf Laundramate Gre... Catch Buina
f---
SIIIIo: Water Softenero Sump Pump" Ejectoro
Water Heate.. sanUary Bubble.. Bar and Soda Waste.
Shower Baths Urinals
- - -
Floor Dralu Dental Cuspido..
Laundry Tubs Service Sinks
lnapec!1ons Valuation of the Work Herein Descrihed Fee Verüied. Receipted and Recorded Received Permit and Inspection Fees
---------..-.-------------.-----.-.-___-OutBide ,Q)()-() -~_:_-~~_._.Sewer Fees
$ - - ~--- -_:_- --..- ---- _n - - --------...--- n__"-
.-.....---------..--.-n.-----------------...--.-Inlide ___f..-n':':32___PIbg. Fees
=~'J jl;jr:D(p.=~~~-~; $- - --.- --.-. - ---- ------- ---- - - _n - --- ----- -¥<-.~--Total
_n- --------Et¡;¡T,ë;;~,ë;---------"'------'--'
$-----------.__.___n______----------- _n_____...--...---------- Date 7~(). /£>
In the peñormance of thi. work the undersigned owner (or hi. authorired agent) of said premises and hi. authorized Plumber hereby agrea to be boundan by end
submit to .11 st.tutes, city ordinance.. 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 hereinafter listed.
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P'omblng 'n..-.......o.,q- ____n-
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-- Plumb"