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AFFIDAVIT RELATING TO SECTION 13.12 (c) OF A GENERAL ORDINANCE
OF T$8 CITY OF 03~OSH a$LATIIJG TO TAE LICENSING OF ELECTRICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
SS
WINNSBAGO COUNTY )
erg ~ 1, , O 3 ~ ~. L~
Name - -~ Address.
first. being duly sworn on oath, deposes and says that he is not
a licensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residenoe 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
horns-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 electrical work. authorized by
the permit applied for fn connection with this affidavit., mint
be done only by`this affiant and that he cannot employ others to
assist with the electrical work but members of his. immediate
family.._
Dated. this ~.~ day of ~,w,u 19,,;x.
Subscribed and sworn to before
this^_, ~ day of ,~,, 19~..
Notary Public, Winnebago County,. Wisconsin
Mq Commission Egpires:__ g~~.~~o