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7\ E
RE�E�ENC� CARD
PIUMBER �
----------- DATE .1�/��._ __., 11.-- �ERMIT NO...�
NAME Of OWNER _ - __.__ _ � __ __ STREET and NUMlER �r/�,�e`p.-.�.�.._--_.CGQI(�J'._- -.- -
D�scripfion lor 6 ck A�diei�n Ward
OUTSIDE WORK
N�w S. S�w�r WaNr Slorn�s Rday f. f�wn Wafn S�enn� �
---�---- ---- ------- --
From Main to Curb From Main to Curh �
_FPot,� Curb to Bldg. Fr�m Curh t� Bldg.
Electric Pum s Re air �
Se tic Tanks �
INSIDE WORK �
NEW RE►. USED FEES� � NEW REP. USFD FEES I�W� NEW RE�. USED fEEf
E3ath Tub i Garhage Disposals �' Catch Basins �
Wash Basin I� D;sliwa�i�t�r•s �, Conducto.*s �
�--- ;
V1'ater Closet Laundramat� �� Grea�e Catch Basins �
- -- t
Sink Water Suft�ners �ump Pump&Eiectors F
-- �'_, ,_ _ .� —_, __._ _..---=- -- - --_ _ �
Water Ht�aters _ �� Sanitary�� �'��hbiers i� B- �• and Soda V�'astes
Shower Baths -- � i, Ur�nals -- -J'- �--I — -- . Ran�c Boi!ers � — — �
-- -—+----
Fl�or Drains TJental Cu�pidors � �' Fnture Outlets �
'j— - --
I,aundrv Tubs , � �! Service Sin�ks � �
Inspections � Rernarks i ' ��
` ('°t'`,j -g,� �7 9 ---.Se,ti�er Fc e '
Outside �l /?
i (�-'� L��-iLOl.G-1j j
.l� //�J�7 i --_.._—_ -_Plbg Fee= �
�---_.�.,, � ------Inside f
...._._ _ ,�, ! �t U,. /O/�25��79 I •_.�..�__.._ .._�_�____..--- Total �
c.,/ ; � �'aluatir�n ,__ .. �
- /�� �� Final Ol� � O � c � i
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STATE OF WISCONSIN )
) SS
WINNEBAGO COUNTY )
�����" � —_____, �0�� ����,�.�.1 G ,��
a me _.�`"``--
(Adaress )
being first duly sworn on aath deposes and s�y�� that he is not
a licensed plumber, and that he has applied �or. a plumbing
permit to the Plumbing Inspector of th� Cit�r nf Oshkosh, to do
plumbing work in a home owned and occupied by him, or a home
that is being construct;ed that is owned by him, and which wil.1
be occupied by him as his home when completed . That he is not
building said home for the purpose of sa1e .
This affidavit is mad� ior the purpose of complying with
the provisions of the plumbir�g code of the City of Oshkosh and
the State of Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing cscsrk
may be done by one who owns and occupies hi� own home pravidi��;��
the installation complies with the plumbing cc�de of the City uf
Oshkosh and the State c�f Wisconsin .
This affiant under�tands that the Pl�m�iny w�rk a�thoriz�d
by the permit applied for, must be done only bv i:his affi�nt Ur;:�
that he cannot employ c�thers who are not lice�.;=�:�� pltambers tc� '
assist with the work,
Dat ed this �� da y �;f �_ ___ . 19 �
�-____.._-
. �^�__1��'C/' ---___.__._..
_�
Subscribed and sw�rn to �
before me
this day� of __ , lg
Notary Public, Wint�eb�:��:� C�unty, Wisconsini
My Commission Expires :