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I Lot No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Data
NIW SEW" WAf.. STORMS FEES FEES RELAY S. SEWER WATER STORMS fEES
From MaIn to C...b Septic TaDks Foom Main to Curb
From Curb to Building Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
NEW
USED
fEES
NO.
NEW
REP. I USE.
FEES
"°.
UP.
FEES
NEW
REP.
UII.
Batb Tub
Garbage DIs~
Caleb Basins
Wash Basin
Dishwashers
Conduclors
W8ier Cl_t
Laundram&ttl
r-
Grease Catch BaslDs
SIDk
Water Softeners
Sump Pump" Ejectors
LI
v/
[¡"tV
Bar and Soda Wasles
Sanitary Bubblers
WlI!8r Haatars
Shower B8ihs
UriDals
nocno Dr8Ù18
Denial Cuspidors
Laundry Tubs
~:~O:_.._...._--_.._....__........Oul8ide
ServiĊ Sinks
Valualion rork Herein Descrihed
$ó1./)]) <>-<J.
Received Permi! and Inspection F-
---..------------------Sawer F...
_m----k@_..---_Plbg. F..s
_......-/-L-ði2.-_..---_T..olal/..I. .
Dale g'=~-= 2r .
Fee Verified. Receipled and Recorded
---------....-----..---------..--....---------..-..-Inside
..-------..---------..------..-......-------
$..- ---..........--........---..--------..---------..-..---......--....--
$----........--------..---....---..---..---------........------..-------..-
---""---ë-,iÿ-ÿ;;¡;-;;ë;---""---""""--------
---..
--..---------_-..-..---F1DsI OK
In the psrformance of thi, work the undenigned owner (or his authorired agent) of said premises and his authorired Plumber hereby agree 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.
e undersigned that no other uses will be made of the above connections except as hereinafter listed.
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