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City of Oshkosh
Inspection Services Division
215 Church Avenue, PO Box 1130
Oshkosh, WI 54903-1130
Phone: (920)236-5050
Fax (920)236-5084
CTION REPORT
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JOB LOCATION: / S V
CONTRACTOR: p
PROJECT TO BE INSPECTED:
TYPE OF INSPECTION
Violations must be corrected and approved within 30 days unless otherwise noted. Call for re-inspections prior to concealment
and/or occupancy. Upon completing the corrections, the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of
A+1~M :CODE INSPECTION RESULTS ~ . ,, ~ ` <.
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AC~"ION TAKEN: -~ ,
Not Approve p. Report 1 site ^ Not Approved/ Insp. Report given to ^ Mailed/Faxed
Signed ~,~~- ~/~ ~ ~36` ~7sG
Inspe on Services Division Date of Inspection Phone #
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- ~ _ , ~ - certify that ~ V~o~a~Ons listed on this Notice/~~n~>~t ham:
Print Name
Company
Signature: Date