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PLUMBING PERMIT - Oshkosh, Wisconsin
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Permit
N<.' 9137
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Street
and ¡.
Number.
¡ Addition or Replat
I Lot No. r:o:--'- I Ward
OUTSIDE WORK
Date
NEW SEwn WATER STORMS FEES FEES REtAY S. SEWER WATER STORMS FEES
From MaID to Curb Seplic Tanks From Main to Curb
From Curb 10 BuUcllng Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO.
NEW
..,.
USID
NO.
NEW
REP. I USED
"O.
NEW
"ES
REP.
USED
FEES
FlES
Bath Tub
Garbage DllpoA!s
Catch Basm.
1-
Wuh Basin
Dilhwashen
Condudors
Water Clooat
Laundramals
Grease Catch Basm.
SIDk
Water Softeners
Sump Pump Be Ejectors
Water Heaters
7
Sanitary Bubblers
Bar and Soda Wastes
'fJß[J
ShowerBaIhs
Floor Drains
Urinals
Dental Cuspidors
Laundry Tuba
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Senice Sinks
Fee Verified. Receipted and Recorded
Received Permit and Inspection Fe..
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Date I-/::/P G
..................................._.....................lnside
Valuation 01 the Work Herein Described
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In the performance of this work the undarsigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to b. bounden by and
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 hereinalter listed.
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STATE OF WISCONSIN)
) SS
WINNEBAGO ÇOVNTY )
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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 Plu:i1b:in.} Inspector of the City of Oshkosh, to do
plumbing work in i) home owned and occupied by him, or a home
that is bein9 constructed that is owned by him, and which wi1.l.
be occupied by him"s his home when completed. That he is not
building said home for the purpose of sale.
This aff~davit is made for the purpose of complying with
the provj,sions of thE plumqing code of the City of Oshkosh and
the Statf) of Wisco.nsin, which provides that a1.l. plumbing work
must be done by a licensed plumber except that the plumbing work
may be done by one ~ho owns and occupies his own home providing
thf) installation complif)swith the pl~mbing coØeof the City of
Oshkosh and the State of Wisconsin.
This understands that the Plumbing work authorized
by the permit applied for, must be done only by this affiant and
that he ca emplo'J oi;hers who are not licensed plumbers to
assist with work.
Dated this --'Í- day of
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Subscribed and sworn to before me
this -$ day of ---~-, 19..&.
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Notary Public, Winnebago County, Wisconsin
My commission.ExPires:_::~~;?lr~~~~~2~:_---