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HomeMy WebLinkAbout0028047-Plumbing (laterals) ~ CITY OF OSHKOSH N2 PERMIT - APPLICATION AND RECORD 28047 ~~P_E~ _ _ ~L~~ _~ _ ~T~ _ ~ _ ~~E~ _ ~ _ ~~B~ _~ _ ~I~~ _~ _ ~O_N~N_G _ _ _ _ _ _ _F~~~D_ ~L~I~ _ _ _ _ _ _ ~~I~~T_ _ _ _ _ (6P~ &~ ~ ~ ADDRESS PLAN NO. OWNER DESIGNER USE/NATURE OF WORK AJS'Ff--6~;L~~ {f " BUILDING CONTRACTOR Size Sq. Ft. # Rooms # Stories Height Occupancy Permit Foundation Class of Const. HEATING CONTRACTOR Heat 0 A/C 0 Vent 0 Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR Electric Servo New 0 Change 0 Temp 0 Type _ Volts _ Amps_ Fixtures Switches Receptacles Circuits 6 PLUMBING CONTRACTOR ~~ # _WC _Ur _ CBasin -.L San. Sewer --I- Storm Sewer ~ Water w~ V Ir/e.. y fJrJ C I C-- _Sink Other _FDr _LTub _Disp _DW _SP _ WSoft _DF _Lav _WH _Sh _BT ~ _ Eject _SS FEES: Valuation $ ISSUED BY 8-00 ,6 <:) ~/L, Permit Fee Paid $ Date 5 / O~'OC\V" ~f/72- Park Dedication $ Final/O.P. {)-; b - q J. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE ~, ~ ADDRESS ~LL?~ ". AGENT/OWNER L-- DATE TELEPHONE # r-.......,... .- s ADDRESS / g, - DAD -/0.....92- nRHI'r# - K ~ !I.mmn /~ ~ (1;- OWNER NATtm! OF li01UC flJJ2-r-<..-> .sr~ _ C; ~ d-7~_/v NEfl REI.AY BEPAIIl nrrEllIO.,( SAN SEtJ 'ffu L # I r..lA'I'!1I. I~ Bacheub Sump Purno S~ Y jJv C- . LavaCorT Ejector Toilec Water Softener TNSPE CT'I ON DAT!: INsnC'rION DAT!: tci c. Sink Drinkin g Fountain VW/~T~~ ;) _ (0 Sink(other) Tho;n;::!1 bf ~OO. ",,rD W.<lterheater Slop Sink Grease Tran ; Floor Drain Local Waste , Laundry Tub Site Drain Disposal Laundry Standpipe Dishwasher Catch Basin r/ ~_ PL9JmING nllMI'r APPLICATION 6~&~ ~ .2 ~C) f"7 ** ViRla~ian notes Oft ~e ~verse side),