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I Lot No. I Block I Ward I Addition or Replot
OUTSIDE WORK
Date
NIYI SEW" WATER STORMS fEES FE" RElAY S- SEWER WATER STORMS lEES
FROm MaIn to CURb Septic Tanks FROm Main to CuRb
~m ClUb to BoUdlng Electric Pumps FRom ClUb to BuUding
RepaiR
L
..3
3
..1
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L
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INSIDE WORK
NO.
NEW
fEES
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USED
FI"
NO.
NEW
RE'. I USE.
FE"
NO.
NEW
RE,.
USE.
BathTub
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GRe... Catch Bulna
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GaRbage DlIpooaIs
Catch Buina
Wash Buin
Dishwubus
Conductors
Wat.. CI_t
Leund..mats
SIDk
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I
WateR Softeners
Sump Pump" Ejecto..
WateR Heate..
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BaR and Soda Wutes
SanitaRy Bubble..
8how.. Baths
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UriDalI
F1ooR DRaiu
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V
SeRVIce Sinks
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Dental Cuspidors
LaundRy Tubs
Inspactions Veluation of tbe WoRk Herein Described Fee Verified. Receipted and Recorded Received Permit end Inspection Fees
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In the performlnce of this work the undersigned owner (or his luth.ri.ed agent) of said premises and hi. authorized Plumber hereby ag;;;!;, be bounden by and
submit to all statutes. city ordinances. and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
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