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PLUMBING PERMIT - Oshkosh, Wisconsin Permit N? 9628
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Name ¡ , '>~
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I Lol No.
r::-u I Ward
1- Addition or Replat
Date
OUTSIDE WORK
NIW SIWEI WATER STORMS lEES FEES RElAY S. SEWER WATER STORMS FEES
From MaIn to Curb Seplic Tanks From Main 10 Curb
From Curb to BuDding Eleclric Pumps From Curb 10 BuUdlng
Repair
INSIDE WORK
NO.
NEW
USED
NO.
NEW
REP. I USED
FEES
NEW
lEES
REP.
USED
NO.
REP.
lEES
Bath Tub
Garbage DÙlpooa]Jo
Catch BullIS
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Wuh BuiD
DUobwuhers
Conduclors
Water CIONt
Laundramats
Greue Catch BullIS
SIrIk
Water Softeners
Sump Pump iii: Ejeclors
Water Heaters
Sanitary Bubblers
Bar and Soda Wastes
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Shower Baths
UriDals
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noor Drabuo
Denial Cuspidors
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Laundry Tubs
Service SiDb
ImpectJons
Valuation of Ihe Work Herein Described
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Fee Verified. Recelpled and Recorded
Received Permil and Inspection Fe..
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In the performance of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agrae to be bounden by and
submit to all statutes. city ordinances. and rules and regulations prescribed by the Board of Public Works for tho 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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STATE OF WISCONSIN)
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WINNEBAGO COUNTY)
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IName
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being first duly sworr 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 ~iscon5in, which provides that all plumbing work
must be done by å licensed plumber except that the plumbing work
may be done by ~ne ~ho owns and occupies hi. own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin.
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This affiant understands that the Plumbing work authorized
by the permit applied for, must be done only by this affiant and
that he cannot mnploy others who are not licensed plumbers to
assist with the work.
Dated this -¿~ day of ---~ ~. 19Æ
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Subscribed and sworn to before me
this ~r;;day of c12cé-'. ,19??
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Notary PubllC, Winnebago County, Wisconsin
My Commission Expires:
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