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I Lot No. --I Block I Ward I Addition or Replat
OUTSIDE WORK
Dat.
NOW SEwn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaiD to Curb Seplic Tanks From Main 10 Curb
From Curb 10 BuildIDg Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
REP.
FEES
USED
NEW
FlES
NO.
NEW
REP. I USED
FEES
"O.
NEW
REP.
USED
Bath Tub
Gubage Disposals
Calch BaslJuo
Wuh BulD
Dishwuhen
Conduclors
Water ClOMI
I
/'
I---
:~
I i ----
Laundramats
Grease Catch BaslJuo
Sink
Water Softeners
¡..../
Sump Pump" Ejeclors
L
I~
Wai8r Heaters
......
Sanitary Bubblers
Bu and Soda Wasles
Shower Baths
Urinals
I
./
Denial Cuspidors
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Floor Dr8IDs
Leundry Tubs
Senice Sillks
~:~:~_._h n...... ...--... ....Oulside J Valualion of Ihe Work Herein Described Fee Verified. Receipled and Recorded R~~i::,d .~:.r: I.:.n;e:n=lion F...
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In the performlnce of this work the undersigned owner (or his authorired agent) of slid premises and his authorized Plumber hereby a{ree to 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.
undersigned that no other uses will be made of the above connections except as hereinafter listed.
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