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Date I Lot No. \ Block I Ward I AddUion or Replal
OUTSIDE WORK
NIW SEWEI WAtER STORMS FEES 'EES RELAY S. SEWER WAtER STORMS FEES
From MaIn to Curb Seplic Tanks From Mllin to Curb
IBm Curb 10 BuIldlng Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO.
_I-I~I~I~I I-I~I~
'EES
NO.
NEW
REP.
USEO
FEES
L
"7
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CaIcl1 Buins
Bath Tub
Garbage Dilponh
Wub Basin
Dishwashers
Conductors
Grease Catch Basins
I
Laundrama.lll
~
Water Clooet
I
(
Water Softene..
/
Sump Pump 8< Ejectors
Sink
Wa!er Heaters
sanUary Bubblers
Bar end Soda Wastes
Shower Baths
Urinals
1-
I
Dental Cuspidors
n- ])reins
Laundry Tubs
Service Sinks
IlUIpecI1ons Valualion of~e ,Work Herein Described Fee VerUled. Receipted and Recorded Received PermU and Inspection Fe..
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In the performance of this work the undersigned owner (or his authorired agent) of said premises and his authorired Plumber hereby agree to be bounden by and
submit to all statutes, city o~inanc.., and rules and regulations prescribed by the Board of Public Works for the governmant of Plumbers.
'undersigned that no other uses will be made of the above connections except ~,s / "
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