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I L<>I No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Dato
NEW SIWEa WATIR STORMS FEES FElS RELAY S. SEWER WATER STORMS FElS
From Me1n to Cub Septic Tanks From Main to Curb
!')om Cub to BuDding Eleclric Pumpe From Cub to Building
Repair / I,ðò
INSIDE WORK
NO. NEW UP. USID FIlS NO. NEW .EP. USED FElS tlO. NEW UP. USIO FlES
- - - - -
Bath Tub Garbage DispoAIs Ca.Icb Basins
- -
Wash Basin Dishwashers Conduclon
- - - - -
Wet.. Cl_t Laundrama.ls Grease Catch Basins
-
Sink Water Softenan Sump Pump I< Ejeclon
Water Hoaton Sanitary Bubblen Bar and Soda Wastes
Show... Bùhs Urinals
Floor DreiDs Denial Cuspidon
-
Laundry Tubs Senice Sinks
I""pectio... Valualion of Ihe Work Herein Described Fee Verified. Receipted and Recorded Recaived Permit and ¡nspaellon Fees
.......................................................Oulside $.~)?:..................................................-- ........I,..QQ......s.wer F...
.........................................................Inside ..::::Z::ç;:;j:::::~:; Fees
~=~~9~?'=:;:~-;;; $... ................................................................""....
........... """""'Òiÿ'T;~;;~;~;"""""""""""""
$......................................................................-. Date 3-6>- J?'
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
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the gov.-rnment of Plumbers.
It I. futher agreed by the ~nderslgned that no other use. will be made of the above connection. except a. herei
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