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0 CITY OF OSHKOSH
ROOMING HOUSE INSPECTION AND LICENSE APPLICATION
Date
Address of Proposed Rooming House
�� ti \t. „� ;.. �.... 4
Owner "`� Address
t,_} '� r y :�,WW\ ;� \ \e°.,': Address
Operator
Agent designated to receive notices j c, 'tz``
Address ,;
Type of occupancy at present t:;., ,_,., :,, t;k.'
Length of time in present occupancy
Number of sleeping rooms �•'
Maximum number of occupants per sleeping room:
# 1 '� #3
T #5 #7 #9 (FEE)
#2 ;.. #4 r:r #6 #8 # 10
Paid: ?
Bed Linen and towels furnished by
Responsibility for cleanliness of sleeping rooms . - ° ' `
Heating plant is capable of maintaining the premises at 65° F.when the outside timperature is-15° F. -
Water heating facilities are capable of heating water to a temperature of at least 120° F. '--
TO THE HOUSING INSPECTOR: The undersigned hereby applies for a license to operate a rooming house as
described in this application. Operation will be in compliance with the minimum housing code and other ordinances
of the City of Oshkosh and building code of the State of Wisconsin. In accordance with S. 11.13 (11) (d) of the
Municipal Code of the City of Oshkosh, it is further agreed, that the City Clerk will be immediately notified
of any change of agent. In accordance with S. 11.13 (11) (e) of the Municipal Code of the City of Oshkosh, it is
further agreed that written notice will be given the Housing Inspector within 48 hours after transferring or otherwise
disposing legal control of the above rooming house.
Signed:
+. _. . Address
Owner
"" Address
j \ Agent .�.�
License Issued: OFFICE USE ONLY
Date received
Date Zoning
Inspected by
Number Date