HomeMy WebLinkAbout0001003 P
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I LDI No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Date
NEW SEWEt WATER S'ORMS lEES FEES RElAY S. SEWER WATER STORMS FEES
From Mahs to Curb Seplic Tank. From Main to Curb
From Curb to Bulldlng Eleclric Pumps From Curb to BuUCÜJ1g
Repair /'
INSIDE WORK
NO.
RIP.
FEES
NEW
USED
FlES
NO.
NEW
REP. I USED
FEES
NO.
NEW
REP.
USED
Bath Tub
Garbage DilpoI8ls
Catch Basills
¡----
Wasb Basin
Dilbwashen
Conductors
WIIi.. CI_t
LaundramatR
Greasa Cllich Basm.
Sbsk
Wilier Softeners
Sump Pump Be Ejectors
Wilier Hellie..
Sanitary Bubblers
Bar and Soda Waste.
Show.. BathJ
Urinals
Floor Dr"
Dental Cuspidors
Laundry Tubs
Service Sinks
Inspections ---------m--Oulside
~=::::~:::::::~::=::=:::::=:::_-------_-_--_mInside
Valualion of the Work Herein Described
$--~s.3_~--mm_____--_.___m_mm_._-
Received Permit and Inspection Fees
n_.I'm"'-QmmnSewer Fees
--- m--__m--mm_--PIbg. F..s
m/~--ç<?__....__Total
Date / - (D .- '76'"
Fee Verüied. Receipled and Recorded
~=q79-"J7-:7-=~~---~;
$----.---.-------.----_--_.__m_m--___--_----------------.---.-._m_---
$--------------.--.--------.-.-- ----'--'--"---______m_m______-------
------ --_m-ëííÿ-Ÿ;;;.õ;¡;;--------------__-___m__.
In tho porfo~m.nc. of Ihis work tho undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agr.. to b. bound.n by ond
submit 10 all statut... city ordinances. and rules and regulalions prescribed by the Board of Public Works for the government of Plumbers.
ndersignod that no other uses will b. made of the above connections .xcept as herelnoft.r listed.
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