HomeMy WebLinkAbout0025673-Plumbing (laterals)
~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
25673
~~:E~~ BLD~ _~ _ H;G~ D;;E~~N _: :NIN_G_ _ _ _ _ _ FLO~D PLA:~~ ~~_ _ ~~'GHT _ _ _ _
OWNER S /~~ ,fl-~~
(/
DESIGNER
USE/NATURE OF WORK
A)~ ~f---I{-
a~P7/
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 NC 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
It
PLUMBING CONTRACTOR
T V~ Ik-~.-/~
_BT _WH _Disp _ WSoft
.
_Lav _Sh _OW _OF
_WC _FOr _SP _Ur
_Sink _ L Tub _ Eject _SS
Other
_ CBasin
iSan. Sewer
~...~cfK:-
(f iP0 ~
_ Storm Sewer
~ Water I v'~ C~
de c:, (1 0
FEES: Valuation $ # > -, ~ Permit Fee Paid $
ISSUED BY W ~J...A.U:; Date
/
~ 0.. {') tj /"
/0 ~7- '//
"
Park Dedication $
Final/O.P. if) - <j ~'Y I
I . ~
In the performance of this work I a2gee to erform all work pursuant to rules governing the described construction.
/) If ~A.. 1 )0- /.-
SIGNATURE ~ _~~
AGENT/OWNER DATE
91
ADDRESS
TELEPHONE #
SAN SEW V f1}~ I iff:
WATER /~ Bathtub Catch Basin
~,.nRM . SEW Lavatory Grease Trap
Toilet Sump Pump
INSPECTION DATE INSPECtiON DATE Kit. Sink Local Waste
'ItJ IO-F Sink(other) Site Drain
Shower Laundry Stand Pipe
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
n,..inals Future outlets
ADDRESS
OWNER
NATURE
,.
s
n ~"""'
PERMITiff: -- -.:- G ?.:l.
~~~e
NEI.)'
RELAY
REPAIR
1** Violation notes on the reverse side!