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I Lol No. I Block I Ward I Addilion or Replat
OUTSIDE WORK
Dale
NIW SEwn WATER STORMS FEES FEES RElAY S. SEWER WATER STORMS FEES
From MaID to Curb Septic Tanks From Main to Curb
~ Curb to Building Electric Pumps From Curb to Building
Rapair
INSIDE WORK
110. NEW UP. USED FEES NO. NEW REP. USED FEES "0. NEW REP. USED FEES
.I ~
I Batb Tub j,O() Garbage D~ Caleb Bulns
;/ ~
I Wuh Buin /,00 Dlshwuben Conductors
~ - ~ - -
/ Waler C~t ,/ ,oD I LaundrllllUlt8 V l,aD Greue Caleb Bulns
~
I SIDIo: V /,00 Waler Softeners / Sump Pump" Ejectors ¡/ I,c;
/ Waler Healers V /. C)O Sanitary Bubblers Bar and Soda Wastes
Shower Batb8 Urinale
/ Floor Drelns V j,t)ð Dental Cuspidors
Laundry Tubo Service Sinks
Inspections ;/2;~ ~:r_~ --=::::-:::==: Fee Verified. Receiptodand Recorded Received Permit and Inspection Fees
~~ -------------------..-------Sewer F...
--------,g:Oß_---_.PIbg. Fael
$------------------------.--.--------------.---------------.--------------- D~;:---~t:~h/
I $------------------------------- ---.------.------------------.----------- .-----------------.h------Ciiÿ-ÿ;;;;;;;ë;----_----h---------.-----
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In the performanca of this work tho undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by 8ftd
lubmit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It Is futher agreed by fte undersigned that no other U58S will be made of the above connections excJJ>t as hereinafter ..IIited.