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I Lot No. I Block I Ward I Addition or Replal
OUTSIDE WORK
Dale
NIIW SEwn WATER STORMS fEES 'EES RELAY S. SEWER WATER STORMS 'EES
From MaIn 10 Curb Septic Tanks From Main 10 Curb
~ Curb 10 BuUclIng Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
110.
IIaIh Tub
-y Wuh Buln
y Waler C10l81
-
L Sink
f Waier Healen
Shower BaIhI
/ n- Dralna
NEW I U,. I USID I FlES I NO.
V
./
V
.,/
vi I I( /'
/1 I I r/
NEW
RE'. I USED
fEES
NO.
NEW
REP. I USED
'EES
-,-
Garbage Dilpooa1s
Calch Buins
-~-,-,
1-1/r-
_Ir-
Dilhwuhers
Conductors
v
¡/
Laundramaill
Greue Calch Buins
Waler Softeners
Sump Pump 8< Ejeclors
j--
Sanitary Bubblers
Bar and Soda Wules
Urlnala
Denial Cuspldon
Laundry Tubs 1 I I 1 I I Service Sinks
Inspecllons f Valuation of t~e W rk Herein Described 1 Fee Verified. Recelpled and Recorded
-----------------.- ---- :_----- ------------Outside ð<'-
'-R~ tj1¡;;/ /' r st2C!1K2--- -.-.--------------------------------------
j::c_--/,,---------/f.!'/-,-----.-.--------------Inslde
----------------.-----------------------------------
--4Ar.Il-9---------_--FlnaI OK
In tho performance of this work the undersigned owner (or his authorized agent) of said
submit to all statutes. city ordinances. and rules and regulations prescribed by the Board of
Received Permit and Inspection F....
---.-------.----------------Sewer Fees
-------I.!t._æ____plbg. Fees
j -----.l!L_~...--1;olal
Date /1
n______-----------------------