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I Block I Ward
I Lot 11'0.
[ Addition or Replat
Dato
OUTSIDE WORK
NIW SEwn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS lEES
From MaIn to Curb Septic Tanks From Main to Curb
nom Curb to BuUdlng V'. ~/ !f;¿;r) Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO.
NEW
REP.
NO.
NEW
REP. I USED
NEW
fEES
REP.
USED
FEES
"O.
USED
FlES
Bath Tub
Garbage Dl8pooab
Catch Basins
I-------
Wub Basin
Dl8hwashen
Conductors
Water CIONt
Laundr8D1ll.b
Gre... Catch Basins
f---
Sink
Water Softeners
Sump Pump" Ejectors
Water Hoaten
Sanitary Bubblers
Bar end Soda Waste.
Shower Baths
Urlnelo
"ocr Dralu
Laundry Tuba
Dentel Cuspidors
I~-
Service Sinks
~~.:_n_n--_--nn__..n.--.Outmde :~;l~~~~r.:n:::::.::::.:: Fee Verified. Receipted and Recorded Rec.ei:5.~f--.S:~e:ns:':lion F-
=.:-~~ . ~..:~-======= --0;=---- n.>o~1Þ;; ;::.
In the peñormanca of this work the undersigned owner (or his authorirad agent) of said premises and his authorired Plumber hereby agr.. to ba bounden by and
submit to all statutes, city orelinaneas, and rules and regulations prescribed by the Board of Public Works for the government 01 Plumbers.
It is luther agreed by thaAcI'ersigned that no other uses will be made 01 the above connections except as hereinalter listed.
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