HomeMy WebLinkAbout0021641-Plumbing (laterals)
~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
21641
TYPE:
BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
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OWNER /
DESIGNER
USE/NATURE OF WORK
j)~ SF'--
~4
,
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
EL~CTRIC CONTRACTOR
Electric Servo
New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
~ BT ~WH
2.- Lav -.L Sh
::> WC ~FDr
-.L Sink -.L -t::=fob.6L.W
~~
---L Disp
iDW
~SP
_ WSoft
_DF
_ CBasin
w/c.-
_ San. Sewer
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
Other
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FEES: Valuation $ 8s:-00. -
W~
v
Permit Fee Paid $
Date
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. . r
C:-Y:DO.
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/ /
Park Dedication $
Final/O.P. 1....12- '?J
t. ,
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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\
~OWNER
\(<2.-(-<40
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
NATURE
~c..:.-AfnUMBING PERMIT APPLICATION
/ ?? f( 1R~ ~ T- ,- .0 DATE;7 - c> 'C. - ~O. PERMITI!
6-eJfe~ _~'--- if. PLUMBER W~ .
OF WORK ---'JJ ~ s: /:::-
NEW RELAY REPAIR INTERIOR
2/~Y/
.
~
SAN SEW :fft {k
WA TE~l 2- Bathtub II Catch Basin
STORM SEW ? Lavatory /11 Grease Trap
:7 Toilet III / Sump Pump ~T
INSPECTION DATE INSPECTION DATE I Kit. Sink , Local Waste
MG- -0 If- 1;J{1:' Sink(other) I Site Drain
I Shower I I Laundry Stand Pipe I
L/1?~-(1JwrJ CJ~~ /:P-Y:hJ I Floor Drain I / Laundry Tray
F tj/&/7'/ 1 Disposal I Wat. Softner
I Dishwasher I D. Fountain
t Water Heater J Ejector
Urinals Z Future outlets
.-
.-To~ IJv U ~
/"~* Violation notes on the reverse side}
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