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I Lot No. I Block I Ward I Addition or Replat
OUTSIDE WORK
N-
of
PIIIJIIbu
Date
NEW SEwn WATER STORMS FEES FEES RElAY S. SEWER WATER STORMS FEES
From MaIn 10 Cwb Septic Tanks From Main 10 Curb
F>om CW'b 10 BuDding Electric Pumps From Cwb 10 Building
Repair
')
!2
-3
1ft
L
1-
L
L
I
,~
NO.
NEW
UP.
RES
INSIDE WORK
NO.
NO.
FEES
USED
BathTub
./
v
e¿,a, I
,00
,œ) /
NEW
"P. I USED
FEES
NEW
REP.
USED
Garbage Dis»D1181s
./ ~-~ 8?)'
V; -1-~::
I/,ðð
Wuh Basin
WatN CI_I
/"
./
¡/
,/
~-
,tlO
/,{)Zi
400
Catch Basins
DisbwashHS
Conductors
SIDk
" {TO
Grease Catch Baslna
Laundr8IDÙII
Water Sofleners
I
Sump Pump" Ejeclors
......---
Water Heaters
ShoWN Baths
noar Dra1na
L
./
Sanitary Bubblers
Bar and Soda Wastes
Laundry Tubo
Urinala
Denial Cuspidors
Service Sinks
Fee Verified, Receipted and Recorded
Inspeclions
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Valuation of the Work Herein Described
$___-<iI.2J.=~__-----------------------------
$--------..----- -------------------.----.--.---.---------.--------.-.-----
$----------.---------------------------------------------------.----------
Received Permit and Inspecllon Fees
----------------------------Sewer F...
./8:.t2_?'-----_PIbg. Fee.
D:~f;~-=-;/
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City T,...o."
In íhe performance of this work the undersigned owner (or his authorired agent) of said premises and his authorired Plumber hereby agree to be bounden by end
submit 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.¿!Jle undersigned that no other uses will be made of the above connections except as hereinafter listed.
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Plomb..
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