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STATE OF WISCONSIN ) �
) SS �
WINNEBAGO COUNTY ) �
a
�J�� �c �l PY'r� �U � //J/ / �
(Na me . ' �d`�'�v�.eLO �:
( re�s ) €
bEing first duly sworn on oath deposes and says that he is no�
a licensed plumber, and that he has applied for a plumbinq � �
permit to the Plumbing Inspector of the City of Oshkosh, to d.:> �
plumbing work in a home owned and occupied by him, or a home � ;
that is being constructed that is owned by him, and which wil� '
be occupied by him as his home when completed. That he is no� �
building said home for the purpose of sale.
�
This affidavit is made for the purpose of complying with �
the provisions of the plumbing code of the City of Oshkosh a�d �:
the State of Wisconsin, which provides that all plumbing work �
must be done by a licensed plumber except that the plumbing �ro�:!; `
may be done by one who owns and occupies his own home providinn �
the installation complies with the plumbing code of the City cr
Oshkosh and the State of Wisconsin . �
�
: This affiant understands that the Plumbing w�rk authorize� �
by the permit applied for, must be done only by this affiant anc� �
that he cannot employ others who are not licensed plumbers to �
assist with the work. �
Dated this � day of =
_ � lg��� �
� �
2 �
Subscribed and sworn to before me �
� �
this �_ day of % ""�� ��- � 19��. �
�—_ —� / -- ;
mo �. n�� �_Q Q ;
�
�ToLary Public, Winnebago County, Wisconsin
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