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NO. ': : ;-
0 CITY OF OSHKOSH
ROOMING HOUSE INSPECTION AND LICENSE APPLICATION
1 1
Date !� �. ,\,' Address of Proposed Rooming House
Address
A
Owner '.-,► �
Operator
Address
Agent designated to receive notices
Address
Type of occupancy at present
Length of time in present occupancy
Number of sleeping rooms
Maximum number of occupants per sleeping room:
# 1 #3 #5 #7 #9 (FEE)
#2__ #4 #6 #8 # 10
Paid: • _,.'.>
Bed Linen and towels furnished by
Responsibility for cleanliness of sleeping rooms G- ; ` `
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.
' `1- a
.SI�QG1 ..��.I Y r` •r. . t. �� Address ft ..r ,.,
Y_ .
.- -,/ '°
ress
Owner
Agent Address
License Issued: , t OFFICE USE ONLY
i - Date received
Date Zoning ■
L r j Inspected by x w..T,.:--' 4 :,...,....
Number
Date `�{'{ '^. , r
CITY OF OSHKOSH NO.
ROOMING HOUSE INSPECTION AND LICENSE APPLICATION
Date _Address of Proposed Rooming House
Owner Address
Operator Address
Agent designated to receive notices_
Address
Type of occupancy at present
Length of time in present occupancy
Number of sleeping rooms
Maximum number of occupants per sleeping room:
# 1 #3 #5 #7 #9 (FEE)
#2_ #4 #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:
Owner Address
Agent Address
License Issued:
OFFICE USE ON LY
Date received
Date
Zoning
Inspected by
Number Date