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0
OSHKOSH
ON THE WATER
Job Address 3123 HAYWARD AVE
CITY OF OSHKOSH
No
118534
PLUMBING PERMIT - APPLICATION AND RECORD
Owner C C & R WOOD PRODUCTS INC
Create Date 0311412006
Contractor FORREST PLUMBING LLC
Category 401 - Residential-Exterior (laterals)
Plan
Bathtub 0 Shower 0 Water Softner 0 WaitSt 0 Shamp Sink 0 Coffee Maker 0
Whirlpool 0 Floor Drain 0 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory 0 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
Toilet 0 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZValve 0
Res. Sink 0 Dishwasher 0 BeerTap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0
Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0
Water Heater 0 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters 0
Site Drain 0 Breakrm Sink 0 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs 0
Roof Drain 0 EjectorlGrind 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
Misc. 0
Fixtures
UselNature
of Work
NSFR WATER,STORM AND SANITARY LATERALS ""DEBIT ACCT
Size Material Type # Conn. Type
Sanitary Sewer 4" Plastic Lateral 1 New
0
0
0
0
Storm Sewer 4" Plastic Lateral 1 New
0
0
0
0
Water Service 1-114" Plastic Lateral 1 New
0
0
0 Parcelld #
0 1342880000
$950.00
Plan Approval
$0.00
Permit Fees
$150.00 D Permit Voided I
Valuation
Issued By
Date 0311512006
In the performance of this work, I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the
easement holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Address 5210 N LOOP RD
AgenUOwner
LARSEN
WI 54947 - 0000
Telephone Number
920-836-3986
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.