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� AFFIDAVIT F3ELATING TO SECTION 13.12 {c ) OF A GENERAL ORDINANCE
OF THE CITY OF OSHKOSH F?ELATING TO THE LICENSING OF ELECT�?ICIANS
AND PAOVIDING PENALTIES
STATE OF 4�ISCONSIN)
) SS
WINNEBAGO COUNTY ) �
� , `.
� ��'`,�' � 4 �� � ( �;, �>_ ,—„ � � ��:;I _� : . _ . � �/
Name Address
first being duly sworn on oath, deposes and says that he is not
a �iaensed electrician in the City of Oshkosh and that he has
apgl�ied for an electrical permit to do electrical work in a
residenae and/or auxiliary buildings (intended solely for pur-
poses associated with a residence ) which is own�d and occupied
by him, or is being constructed in his name , as his personal
home and that said residence or auxiliary buildings being so
wired are not �o 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 applled for in connection with this affidavit , must
be done only by th3s affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
faoily.
�
Dated thls _ � � � day of ; �: � -�,-�.,,-,r , 19,�%•
, ' - � ���� ��- --
Subscribed and sworn to before `_�
� --
T�i.s C� day of _�. - �. �,�� , 9� _� .
4 � 1 �
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Not�r.y Public, Winnebago County, Wisconsin
My Cn�nission Expires: � � ��- ��2e
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