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AFFIDAVIT FZELATING TO SECTION 13•1Z (c ) OF A GENERAL OFiDINANCE
OF THE CITY OF OSHKOSH F?ELATING TO THE LICENSING OF ELECTAICIANS
AND PROVIDING PENALTIES '
STATE OF WISCONSIN)
) SS
WINNEBAGO C4UNTY )
i�%�/���C ,T C/f TE����G , /c� � LC y��,,� � �r��
Name� 7AlZre s�
first being duly sworn on oath, deposes and says that he is, not
a lioensed electrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and/or augiliary buildings �intended solely for pur-
poses assooiated xith a residence) which is owned and occupied
by him, or ts being constructed in his name , as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used ar ereated for ren�al purposes or for
resale to present or prospective purchasers.
Affiant understands that the electrical work authorized by
the permit applied for in connectian with th�:s affidavit, must
be done only by this affiant and that he cannot empZoy others to
assist with the electrical work but members of his immediate
family.
Dated this 9 day of ,ryl�},E'CfH� __._r__, 19 �S:
__���-� Q �'�.�v�G�o,�
�
Subscribed and sworn to before
thi � day of , 19 OJ .
Notary p�blic, Winnebago County, Wisconsin
� My Commission Expires: �3 ��/ ��
A
PERMIT N0.�9� C � APPL. DATE � —l� � �S
ELEC. CONTR. -
, �
OWNER �e �
�
ADDRESS " / Cr% �' � — � �J C�-U��G"�
NATURE OF WORK �
ELEC. SERV. NEW CHANGE '�FC�
DESC. TYPE VOLTS AMPS
FIX' S /u �1/ REC PT S CIRC' S
APPLI CES �
SIGNS
INSP. ROUGHIN SERVICE FINAL , -g,Jf
EXT. COST C��--�� PERMIT FE '���ATE PD 3- ���
REMARKS ' '
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