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CITY OF OSHKOSH N 35101
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG, SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /47 7 v la
PLAN NO.
OWNER -0 h- v (f
DESIGNER
USE /NATURE OF WORK �'�j
C L C P
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System
Heat Loss BTU'S
ELECTRIC CONTRACTOR
Elebtric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 0.--c--e.)-7-%-e_
I BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
1- WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation Ye 0 0 a Permit Fee Paid i� int d
Park Dedication
ISSUED BY Date 7 s'
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE b0144 s 7 Z7_ q 3
AGENT /OWNER l
I DATE
ADDRESS ___J 7 WCUEi T fF L E Le 233 4 i 7
TELEPHONE
STATE OF WISCONSIN
SS
WINNEBAGO COUNTY
PAN (EC__ �RifLE14 -4-ls, t 2_ 37 tAme F �«t �2 VJ4q f'
(Nam (Address)
being first duly sworn on oath deposes and says that he is not
a licensed plumber, and that he has applied for a ,lumbing
permit to the Plumbing Inspector of the City of Oshkosh, to do
plumbing work in a home owned and occupied by him, or a home
that is being constructed that is owned by him, and which will
be occupied by him as his home when completed. That he is not
building said home. for the purpose of sale.
This affidavit is made for the purpose of complying with
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing work
may be done by one who owns and occupies his own home providing
the installation complies with the plumbing code of the City of
Oshkosh and the State of Wisconsin.
This affiant understands that the Plumbing work authorized
by the permit applied for, must be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work.
Dated this 7' 7i day of Z lg 3
A3444/I
rti
Subscribed and sworn before me
this
.q..146 day of 103
S
Notary P iic, Winnebago County, Wisconsin
My Commission Expires: /9rA
(74ca
l"
PL INC PER) C
T APPLICATION
ADDRESS
3 7 M// /1/ DATE 7/ V7_.? PERMIT# 3 5 7 0
OWNER .s ,;ER
NATURE OF Wont F.--c L_ Z
NEW RELAY REPAIR INTERIOR
SAN SEW
WATER f Bathtub Sump Pump
STO� Lavator9 Ejector
Toilet Water Softener
DA I NSPECTION DATE Kit. Sink Drinking Fountain
Sink other) Urinal
:_i f 01 1',�j Waterheater Slop Sink
r` ,Shower Grease Trap
fl, 1
Floor Drain Local Waste
11 1 Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
IffR��i INNINII■w
'ir v
■•p /7-7
Violation on side( 3 L i�
V o notes the reverse