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STATE OF WISCONSIN ) 5
� ) SS �
WINNEBAGO COUNTY )
J' c�l � •
(Name . , d-i.S�/ ����� ��
(Address )
being first duly sworn on oath deposes and says that he is n�t
a licensed plumber, and that he has applied for a plumbina
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 beinq constructed that is owned by him, and which ��ill
be occupied by him as his home when completed . That he is no}
building said home for the purpose of sa1e. 4
This affidavit is made for the purpose of complying with '
the provisions of the plumbing code of the City of Oshkosh anc�
the State of Wisconsin, which provides that all plumbing work R
;
must be done by a licensed plumber except that the plumbinq �,��;��; �
may be done by one who owns and occupies his own home pravidir�
the installation complies with the plumbing code of the City ot
Oshkosh and the State of Wisconsin.
This affiant understands tha� the Plumbing wo rk authorize�+
by the permit app],ied for, must be done only by this affiant ar,c7
that he cannot employ others who are not licensed plumbers to
assist with the work.
a
Dated this / � day of ��� ��j� �...�
� 1g �
,�
Subscribed and sworn to before me
this day of , 19� .
� �
No�ary P hiic, n bago County, Wisconsin
My Commission Expires ; r°` �"�
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