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STATE OF WISCONSIN )
) SS
WINNEBAGO COUNTY )
i
. r a /� � ,!i e , 3/� �=_ /f/ u,
(Name). �— (Address C �
being first duly sworn on oath deposes and says that he is not
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 con5tructed that is owned by him, and which wili
bP occupied by him as his home when completed. That he is nat
building said home for the purpose of sale.
This affidavit is made for the purpose of complying wi'�h
the provisions of the plumbing code of the City of Oshkosh arad
the State of Wisconsin, which provides that all plumbing work
must be done by a licensed plumber except that the plumbing ssao,r�c
may be done by one who owns and occupies his own home providincr
the installation complies with the plumbing code of the C�_ty o`
Oshkosh and the State of Wisconsin .
This affiant understands that the Plumbing work authorized
by the permit applied for, must be done only by this affiant ar.d
that he cannot employ others who are not licensed plumbers to
assist with the work.
Dated this � day of � s 19 �/
� �
------
`X' /]�� �
/�\�////A��1 /� ' i1 � ��a /la 1� .
Subscribed and sworn to before me
this /7 day of 19 ��
,
Notary public, Winnebago County, Wisconsin
My Commission Expires ;
My Commission Expires Nov. 28, 198�
.
r
.
YLUMBING Pr�RMIT APPLICATIOiv
PLUMBER �Gv/��i-- DATE ��9�
NAME OF OWNER �Gv��j� ti ADDRESS 3/� � � �C
�.�' ���/ > ' � - /��`!', ��/&' 6'/
����h��
�°1 9�v��/
NEW SAN. WATER STORM RELAY SAN. WATER STORM
� Main to Curb Main to Curb
Curb to Bld . Curb to Bld .
Elect. Pum s Re air
Se tic Tanks
NEW REP. �?EW REP. NEW REP.
Bath Tub Gar. Dis osal Catch Basin
Wash Basin Dishwasher Conductors
Water Closet Laundramats Grease C.B.
Sink Water Softener Sum Pum
Water Heater San. Bu'�blers Bar Wastes
Shower Bath Urinals � - � Ran e Boiler .
Floor Drain Dental Cus idors Future Outlets