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Plumber
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I Lot Jlo. b I Ward I Addition or Replat ./
OUTSIDE WORK
t
Date
NIW SEWD WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn to Curb Seplic Tanks From Main to Curb
From Curb 10 BuDding Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO.
NEW
UP.
USID
NO.
RES
NEW
RE,. I USED
FEES
"0.
NEW
RE,.
USED
FEES
Bath Tub
Garbage DiI~
Catch Bulns
I----
Wuh BulD
Dilhwuhen
Conductors
Water CI_t
Laundramall
Grease Catch Bulns
+--
SIDk
Water Softeners
Sump Pump" Ejectors
~I
/':'-
Bar and Soda Wutes
Water Heate..
Sanitary Bubblers
v
Shower Bathl
Urinals
~H---
Floor Dr8iDI
Laundry Tubo
Dental Cuspidors
I-----
Servlee Sinks
Inspecliol18 .........Oulaide
~:~:::::::::::::~::=::==::::=::::::::::._.._...Inside
Valualion of the Work Herein Described
s~.~.................._.._.._................
Received Permit and Inspection Fees
...."......................Sewer Fees
D~~i~;;;yS
Fee Verified. Receipted and Recorded
.
..
-......--....-.-...........---F1Dal OK
0
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City T.......,
In the performlnce of this work the undersigned ownlr (or his authorizld agent) of said premises Ind his author Ired Plumb;~ -';;;;by Ig/ee to be bounden by ond
submit to all stltutes, city ordlnlnceo, and rules Ind regulltions prescribed by tho Board of Public Works for the government of Plumbers.
It is futher agreed by the undersign..J<!lthlt no other uses will be mede of the above connections except IS hereinlftor listed.
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