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PLUMBfNG ~ERMIT - Oshkosh, Wisconsin, > Permit N(: 8413
Kame -tl Kame Street
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I Lo.I No. I Block I Ward I Addition or Replat
OUTSIDE WORK
DaÞ
NEW SEwn WAUR STORMS FEES .... RELAY S. SEWER WATER STORMS fEES
From Main to Curb Seplic Tanks From Main to Curb
From Curb to BuilcI1ng Electric Pumps From Curb to Building
Repair
INSIDE WORK
NEW I REP. -
NO. NEW IW'. USED FI.. NO. USE. FEES NO. NEW REP. USE. FEES
Bath Tub Gubage DilpooaIs Ca!ch Basins
I-
Wub Buill Dilbwubers - Conductors
7 - ¥i;.ðÒ
Wat... CI"""t Laundr&Dlatl Gr.ase Catch Basins
SbIk Water Softeners Sump Pump 8< Ejectors / .ll
Water Heaters Senliary Bubblers Bar and Soda Wastes
Sho..... Batba Urinals
Floor DrIllDa Dental Cuspidors
Laundry Tubs Service Sinks
IDlpectloDl y uation of the Work Herein Described Fee Verified, Receipted and Recorded Received PerIDÜ and Inspection Fees
--------------_____Outsida $...L_a6.o~-.6..-é._._._.__._--------_..._------- .-=~....._..__Sewer Fees
.------------_____--IDIide ;l. - .-.ð:.J.-PIhg. Fees
--------------- $....------------.-..--.-----------...---......----. ----~--@.-Tofal
~--_..._-----Final OK $--.---------..-...-----------.--.-- -----"'------.-"""CliĊ¸Tr..;~;;;-_._-"'----------_." Date ?,//O/~~
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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 agree to be boundan 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 .s hereinafter listed.
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Plumbln. 'n'_'
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STATE OF WISCONSIN)
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WINNEBAGO COUNTY)
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U (Name.j
¿Ud.ø. £'><2... 4~//o //vu?....
...., (A~dretrT~""'-~~--
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 Plumbing Inspector of the City of Oshkosh, to do
plumbing work in a home owneq and occupied by him, Or a home
that is being constructed that is owned by him, and which will
be oocupied by him as his home whe.n c;ompleted. That he is not
building said home for the purpose of sale.
This affidavit is maqe for the purpose of complying with
the provisions of the plumbing code of the City of Oshk6sh and
the State of Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may be done by one ~ho owns and occupies hi~ own home providing
the installation Coi1:pJ.ies with the plumbing c;ode of the City of
Oshkosh and the State of Wisconsin.
This affiant understands ~hat the Plumbing work authorized
by the permit éipp.1.i('d fer, must be done only by this affiant <;Ind
that he ca (¡¡'¡plo" others who are not licensec;i plumbers to
assist with werk,
Dated this _/o,:,::<C¡ay of --~í.;!....J.'f.----~----' 19_->-~:-
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Subscribed and sworn to before me -- -
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Nota ry Put>i ie, WinnGbago county, Wis consin
MY COMMISSION EXPIRES
My Commission Exoires: MARCH 12,1978
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