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0098910P
OSHKOSH ON THE WATER .lob Address 1018 VAN BUREN AVE Contractor SAMMONS PLUMBING Bathtub 0 Shower Whirlpool 0 Floor Drain Lavatory 1 Lndry Tray Toilet 1 Lndry Stndp Res. Sink 0 Disposal Bar Sink 0 Dishwasher Water Heater 0 Sump Pump Site Drain 0 Classrm Sink Roof Drain 0 Breakrm Sink CITY OF OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD Owner LANA J SIEBERS Category 410 - Residential-Interior 0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0 0 WaterSoftner 0 Drink Ftn 0 ServSink 0 0 Local Waste 0 Wait. St. 0 ShampSink 0 0 CIothesWshr 0 Ice Chest 0 FIr/Wst Sink 0 0 Bidet 0 Exam Sink 0 Catch Basin 0 0 Beer Tap 0 SculrySink 0 Wash Ftn 0 0 Dent. Oper. 0 Hand Sink 0 Urinal 0 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 No 98910 Create Date 12/04/2002 Plan Gar Drain Soda Disp Coffee Maker Int Grease Trap Ext Grease Trap Use/Nature SFR/Install toilet &lav. of Work Valuation Issued By Sanitary Sewer Storm Sewer Water Service Size Material Type # $1,500.00 Plan Approval $0.00 Permit Fees Conn. Type 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 $20.00 Date 12~04/2002 Permit Voided In the performance of this work, I agree to perform all work pursuant to rules governing the described construction. Signature Date Agent/Owner Address 522W. MURDOCKAVE OSHKOSH WI 54901 - 2298 Telephone Number 231-9880