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AFFIDAVIT F�ELATING TO SECTION 13.12 (c ) OP A GENERAL ORDINANCE . �'
OF THE CITY OF OSHKOSH AELATING TO THE LICENSING OF ELECTI3ICIANS h
AND PROVIDING PENALTIES
3TATE OF WISCONSIN) `
r
WINNEBAGO COUNTY ) Ss �
v��) -.
� - d G�- / �,� t
Name Address '
�_
first being dul� sworn on oath, deposes and says that he is not
a liaenaed electrician in the City of Oshkosh and that he has
gpplied for an electrical permit to do electrical work ,in a '
residenae and/or auxiliary buildings (intended solely for pur-
poses aeaociated with a residence) which is owr�ed 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 to be used or erected for rental purposes or for
resale to present or prospective purchasers. `
t
Affiant understands that the electrical work authori2ed by
the permit applied for in connection with this affidavit, mvst
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immed2ate
faoily. �
Dated this ' ;���- �
day of � 1��.
f
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Subscribed and sworn to before
thi s -�,� dsv of ` '
, 19�. .
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Notary Public, Winnebago County, Wisconsin
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