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Q) 0.. l!:? - 0.. co 0.. en co ~ en ~ ~ ~ ~ Cf) a::: :I: LL () Cf) () () W LlJ 0 iL e::( LlJ 0 >. ....J I- Z AFFIDAVIT RELATING TO SECTION lJ.12 (c) OPA GENERAL ORDINANCE OF THE CITY OF OSmtO'SHaELA1'INGTO THE LICENSING OF ELECTRICIANS AND PROVIDING PENALTIES STATE OF WISCONsIN) ) SS WINNEBAGO COUNTY ) M i c..H A~L J f\)OWI c..l.L\ ( Name ) , , I G3~ HR~lt-y (Address) f1rst being duly swo'rn on o~th, deposes and says that he 1s not a lioensed electrician in tqe City of Oshkosh and that he has applied for an electrical permit to do electrical work .in a residence and/or auxiliary 'buildings (intended solely for pur- poses associated .wi.th a residence) which 1s owned and occupied ,by him, or is being constructed in pis 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. Affiant understands that the electr1cal work authorized by .the permit applied for in connection with this aff1davit, must be done only by th1s affiant 'and that he cannot employ others to assist w1th the electrical work but members of his immediate family. Dated this ,-;(/4<.7 day of ~/~- , , 19B Ii, ~~ """,,"-- #'~rC)~ before ~ ~ , 19.J;-/ r Subscribed and sworn Public, Wlnnebago County, \viscons1n E MY 001'J1MiSSION EXPIRES JUNE 7 1987 My Commission xpires:' . . , PERMIT NO./ If 75~).. ' PPL. PATE ELEC. CONTR. .~ ~.rNER 1174. ~~' ) ;2-,} 6 ~ :ht:.CA/v~ ' ~~.# CFlA-NGE VOLTS' ~. RECEPT'S I '#'>""- - /'_ v~ -~, to . ADDRESS = ATURE. OF WORK - ELEC. s~RV. NEW 1?ESC. TYPE KIX'S ~W'S APPLIANCES ' SIGNS INSP. ROOGflI EST.. COST, <<- '-" t? CJ .,~ REMARKS ' .. SERVICE PERMIT FE I ~ - ~' ,,:,.~