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I Lot No. m I Block I Ward I Addilion or Replat
Date
OUTSIDE WORK
NOW SEwn WAIER STORMS fEES fEES RELAY S. SEWER WATER STORMS fEES
From MaID to Curb Seplic Tanks From Main to Curb
From Curb to BuUc\ÙIg Electric Pumps From Curb to Building
- Repair
INSIDE WORK
NO.
NEW
UP.
NO.
NEW
REP. I USED
fEES
fEES
1<0.
NEW
REP.
USED
USED
flES
Bath Tub
Garbage DII~
Catch BasÍIII
Wub Basin
Dishwash....
Conductoro
Water CIOl8t
Laundramats
Gre... Catch BasÍIII
I--
Siak
Water Softeners
Sump Pump II: Ejectoro
LI
.,/
1/ ------
Sanitary Bubblero
Bar and Soda Waste.
Wuar Heaters
8hower Batha
Urinals
Floor DralDa
Dental Cuspidors
Laundry Tuba
Service Sinks
Valuation of the Work Herein Described
rs2çlQ.Z--......m......m_--_.....--..--.-
Received PermU and Inspection Fees
00000000000 --mSewer F...
m./nqpm--.Plbg. Fee.
D~~--.Ir:/V;L
Fee Verified. Receipted and Recorded
~?~~~=::=:::::::==:::::::==::::::~~:
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$... ""............000..000"",.....000._....000"'--"""'.000'".....
$000000""'000'000""'000""--"""""""""-"--""""'--'---
"""""Ci;Ÿ'T;;;.~;;;..............--...._.m
-----..--_.__....m_--_--FiDa1 OK
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In the psrformance of this work the undersigned ownar (or his authorizad agent) of said premises and his authorized Plumber hereby agree to be bounden by ond
.ubmit to all statutes, city ordinances, and rule. and regulations prescribed by the Board of Public Works for the government of Plumbers.
It I. futher agreed by the_undersigned that no other uses will be made of the above connections except as hereinafter listed.
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PI"mber