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Dllie I Lot No. ---------- - I BIOCk_________I_- Ward I Addition or Repllli
OUTSIDE WORK
NEW SEWEI WAT'R STORMS "ES fEES RELAY 5. SEWER WATER STORMS fEES
From MaIn 10 CW'b Septic Tanks From Main 10 Curb
J'om Cub 10 BuDding Electric Pumps From Curb to Building
Repair
INSIDE WORK
110.
NEW
"P.
fEES
USID
flES
NO.
NEW
REP. I USED
fEES
NO.
NEW
REP.
USEO
L
6-
~
I
Garbage DiIpoIaIs
Dishwashers
Bath Tub
Caich BasiDs
Conduclorl
Wuh Basin
I
Laundramall
Wilier CIOI8t
Grease Cllich BasiDs
/
Wilier Softene..
Sink
Sump Pump 8< Ejecto..
I
Wilier Hellien
Sanitary Bubble..
Bar and Soda Wastel
Shower Bath8
Urinals
I
Floor DraIDs
Dental Culpidon
Laundry Tuh8
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Service Sinks
Valuation of Ihe Work Herein Described
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Fee Verified. Receipled and Recorded
Received Permit and Inlpeclion F...
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City T.."".,
In the performenoe of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by and
lubmit to all statutes, city ordinanoes. and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It is futher agreed by t"~ undersigned that no other uses will be mede of the above connedions except a.
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