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PLUM~~ P~MIT - °Jhkosh, Wisconsin PermU N~ 1755
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I Lot No.
l Addition or Replat
I Ward
~
Date
OUTSIDE WORK
NEW SEWEll WATER STORMS lEES lEES R"AY S. SEWER WATER STORMS FEES
From MaID to Curb Septic Tanks From Main to Curb
From Curb 10 Bulldlng Electric Pumps From Curb to Buildlng
Repair
INSIDE WORK
NO.
NEW
USID
NEW
FEES
FEES
NO.
NEW
REP.
USED
FlES
NO.
REP. I USED
REP.
Bath Tub
~
I
II
~-
, /
,-.1
Laundr-
Greue Catch Bulns
Garbage D~
Catch Bulns
Wub Buln
Dishwuhen
Conductors
Water CIONt
Sink
Water Softeners
Sump Pump III: Ejectors
Wmr Heaters
Sanitary Bubblers
Urlne1s
Bar end Soda Wastes
Shower Baths
Li-
Floor Dr"'"
Laundry Tubs
Dental Cuspidors
Service Sinks
~:~~_:--------------.--...._--__----mOulside J I :aI3ti::f :he. w:rk :ereln Described
Fee Verified. Receipted and Recorded
Received PermU and Inspection F-
-----m_--m----m__o.mSewer F-
_.s'm~--~_--mPIbg. Fees
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$-
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City T,....,..
In the performance of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by and
.ubmlt to all statute., city ordinanca., and rules 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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