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STATE OF WISCONSIN )
�i+�I���iEBAGO COUNTy ) JS
)
` �s����s�-�� �__ / ��� � -
(Na me). —_. _ _ �/ij __
� '''-�'�!?�'�'SS )
b�ing first duly �wo�r� �n c�ath deposes �r,u :ays that he is nc�t.
a licensed plumbe�, Gnd that he has appl;.�c� far a plumbincz
permit to the Ptumbing Inspector of the �:ity of. Oshicosh, +u-� c�;_;
plumbing work in a home owned and occupied by him, or a home
, that is being constructed that is owned by him, and which wi11
be occupied by him as his home when completed . That he is rot
.
bui3ding said home for the purpose of sale.
This affidavit is a�ac'e for the purpose of cam�lying with
the provisions of the plumbing code of the City of_ Oshkosh an<�
the State of Wisconsin, which provides that a11 plumbing woxk
must be done by a licensed plumber except that the plumbing �.;�.:j!-
may be done by one who owns ar.d occupies his own home
the installation complies with the plumbing code of therC�.tyj�;
Oshkosh and the State of Wisconsin .
This affiant understands that the Plumbing work authorize;�
by the permit agplied for, must be done on�!_y b� this affiant a�;��
t�zat he cannot e�,�,y�,� others who are not � ➢-:�,��sed plumber� to
ass �st with the p,anx!r:,
Dated this �� c�ay of �
�'�� . 19,- ___--._rt :
a�
/ ���
Subscribed and sworn to before me �
t"r.i:� _� day af � .
� 1`�.��- .
----� � �����
Notary puxiic, rair�nebaqo Count , Wisconsin
^ �'�1y C;,:mmis s ion Ex��i�e:,. ;___�
(0 ��_—_______
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