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I Lo.I Ro. ~ I Ward I Addition or Replal
OUTSIDE WORK
Daie
NIW SEwn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn to Curb Septic Tanks From Main to Curb
Fmm Curb to BuDding ../ (...../ ~OD Electric Pumps From Curb to BuUcling
Repm
INSIDE WORK
NO.
NEW
REP.
flES I NO.
NEW
REP. I USED
FEES
NO.
NEW
USED
FEES
REP.
USED
Beth Tub
Garbage Dlaposaio
Catch Bulna
I--
Wuh Buln
Dlabwuhen
Conductors
Waier Cl088t
Laundramall
Graue Caich Buiu
I--
Sink
Waie~ Softeners
Sump Pump" Ejectors
Water aeaien
Sanitary Bubblers
Bar and Soda Wutes
Shower Bethl
Urinals
FioĊ DraIDs
Dental Cuspidors
Laundry Tubs I I I I I I Serrice Sinks
~~:_:_------------------------_--_--Outside t ::;;~f~ ¿~r_:--:::::_:::=-=: Fee Verified, Receipted and Recorded ~ R~e~~,;;~_:"';e;n;:lon F...
-------------------m-----------------------_--------Inside /------- -----------~:4.7'2_------Pibg. Fee.
$------------------------------------------------------------------------- ---------~_!2:Q_--Tota -
-----FiDa1 OK $----------------------------------------------------------------------- --------------ëí;:;-T;;;;;~;~;-------------------------- Datrú J7 ?
In the performance of this work Ihe undersigned owner (or his euthorired agent) of said premises and his author ired Plumber hereby a
s, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
()~- 12 "
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