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AFFIDAVIT FiELATING TO SECTION 13.12 (c ) OF A GENERAL OADINANCE .
OF THE CITY OF OSHKOSH AELATING TO THE LICENSING OF ELECTRICIANS �•
AND PROVIDING PENi�.LTIES �
STATE OF WISCONSIN) '
WINNEBAGO COUNTY � SS
G� , U /�r/' �S�
Name �
Address
first being duly sworn on oath, deposes and says that he is not
a 2laenaed electrician in the City of Oshkosh and that he has
gpplied for an electrical permit to do electrical work ,in a
residenae and/or auxillary buildings (intended solely for pur-
poses asaociated with a residence ) which is owned 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.
�
Affiant understands that the electrical work authorized by
the permit applied for in connection wi�h this affidavit , must
be done only by this affiant and that he cannot employ others to
assist with the electrical work but members of his immediate
fanily.
Dated this � day of `
, 1��..
Subscribed and sworn to bei'ore �
thi s �day of � 19�
►
Z �
Notary Public, Winnebago County, Wisconsin
My Commi s s i on Expi re s:MY ��M���► EzPlt��
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