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AFFIDAVIT RELATING TQSECTION1J.12 (c) OF A GENERAL ORDINANCE
OF THE CITY OF OSBKOSHRELATING TO THE LIC~NSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN}
) 55
WINNEBAGO COUNTY )
.",
dJ'o~~~~
ame C7
, J3/G l-v~~ ce~.
(Address)
first being duly sworn on oath, deposes and says that he lanot
a lioensed electrician in the City of Oshkosh and that he has
appl'ied for an electrical permi tto do electrical work in a
residence and/or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is owned and occupied
by him, or is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
~~I I
.Aff1ant understands that the electrical work.author1zed by
the pe.rml t applied for in connection wi th this. affidavi t, must
be done only by this aff1ant ancl.that he cannot employ others to
assist with the electrical work but members of his immediate
family. .
Dated this
/8
day of
~~
, 19li.
Subscribed and sworn to before
t~~:&:1:!~::f
Nota1:"y Public, Winnebago County, Wisconsin
t:;.... My Comm:1ss1on Expires: .3-l1/ ~?{)' .
\
~~'k9~~
, 19 31.
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PERMIT NO.' ~ .1/ ~ i . ~PL. DATE 5'-1 Y -Zy
ELEC. CONTR. __ ~~J . . . .. .
J/\ \/)$' '.
OWNER (NCv~cd/ %~~?/rl .'
ADDRESS /1/.6 - ~-Lj~. .
NATURE OF WORK ~:~C ~~~.'
ELEC. SERV. NEW ' CHANGE k TEMP .
DESC. TYPE 2.'- 3~;;;;\ ~~ VOLTS /;J.f.~''7-~tJ AMPS~.o0
FIX'S K ~_.k' RECEPT'S. ~ CIRC'S~
APPLIANCES '~
r
SERVIC
PERMIT FE '
.>1 FINAL
~DATE PD..5'=- $-
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