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V
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V
ST~.T E OF WISCONSIN )
SS
WINNEBAGO COUNTY
'dam
~.
~AddreSS~~~
being first, duly s°nrc,~rn on oath deposes and says that he is not
a licensed p1.u~r~~>:>~r, and that he has applied fora plumbing
perrr:it to ~ he I.1.~~;bing Inspector of the City 4f Oshkosh, to do
plumbing work in ~~ ~.~ome owned and occupied b~ him, or a home
that is being ccnstr°ucted that is owned by him, and which will
be cccupiec; by him aY h~.s home when completed. That he is not
building staid hc~~e f car the purpose of sale.
This affidavit is made fob the purpose of complying with
the provisions of thE: plumbing code of the C~,ty of Oshkosh and
the State cf +'iscorsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may be done b,.~ or~P v~ho owns and occupies his own home providing
the instaltati~~n co~;:pd.ies with the plumbing code of the City of
Oshkosh and t.tle :>~ ._~t:e cf Wisconsin,
This .=~f:`,~nt understands that the Plumbing work authorized
by the per~n~.-~, ~~pc~?.i~~d fcr, must be done only by this affiant and
that he ca^~c;~; E?i~ll~1J'/ ol;he~"S who afire not licensed p~.umbers to
assist wit'. f:nE? ~~~orr,.
Dated t!-is ~~_day o f
Subscribed and s~.NOrn to b~forE
this ~ day of
~~ ~~ ~
.._..~..~~~~,...,,._..._.,...,_._,..., ~ 19 ~~ .
~~~rw~~nT ~~ ~A~ ~~
me
19~.
Notary Pt~blzc, Winnebago County, ~fiscons~n
My Commissir~n Expires; MYCO~MY~2010N ExP~RE~