HomeMy WebLinkAbout0047599-Plumbing (cap laterals) � 4 -�-
� CITY OF OSHKOSH
N°- - 47599
`' PERMIT - APPLICATION AND RECORD
: TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG � SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
�
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
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PIUMBING CONTRACTOR
_BT _WH _Dis —WSoft —CBasin �'�
_Lav _Sh _DW —DF —San. Sewer
—WC —FDr _SP —Ur —Storm Sewer
—Sink —LTub —Eject —SS —Water
Other
G� �i '
FEES: Valuation $ � Permit Fee Paid $ �� Park Dedication $
ISSUED BY Date �6�5,/�f� Final/O.P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE � ��- ��2/��� �
AGENT/OWNER DATE
ADDRESS
TELEPHONE M
FIECO$D OF SEWEB AND WATEE DISCONNECTIONS
Date __ O�T S-, I 99 S�
Address of Building�� ��cJ. 7� �UP
Name of Owner �6��1—_ S�fIK> �d��.
Addre s s of Owrle r -(� . � �3 � /���y,�K (�� �rc�9.�-�7
2k` {�o� �- c..�..
Sewer Bealed ��- Property �ine_ ��/ � 19��by ���U/�T -�-��C
Z g�t �i���c ,�T,
Wa�er Disconnected ;a�--Property Line !Q 19�by `c 4
�� �4S't o � �a5� /'�OP�� Sr�c� �uI�P
`-( �-!ruc � �. ro r�f ��� L-�� c-Pv S c o�K«f-�_� �
No sewer and water servi,ces to premises� `i l �-� � �-� -�- (P4��,� ,�G��
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s� e,�
• . I, the undersigned, owner ar agent of the above described property,
agree that all sewer and water services will be discanhected and
sealed by a ma.ster plvmber on or before /G/�/q��
Owner Agen�
Approved for issuance of wrecking or moving permit.
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Plumbing Inspectar
10�'�g:"O5 14�27 a 414 236 51�6 rITV nF n�HY,OSH F,p�
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