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Permit N~ 1155
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Illl . f) PLUMBING PERMIT
~~-_.:or - O.hkosh, Wi......i.
- -................ Owner ........................................
I BIOCk__n______1 Ward
I Lot Ro.
I Addition .or Replat
Due
OUTSIDE WORK
NEW SEWEI WAYER "ORMS fEES fEES RElAY S. SEWER WAIER "ORMS FEES
F...... Main 10 Curb V'" -::(.d) Seplic Tanks From Main 10 Curb
~ Curb 10 BuDding Eleclric Pumps From Curb 10 Building
Repm
INSIDE WORK
110.
NEW
RIP.
FEES
USED
NO.
FlES
NEW
REP. I USED
FEES
NO.
NEW
REP.
USED
BUb Tub
Gubage Dlaponla
Catch Basins
Wash Basin
Dishwashers
I~-
Conduclors
Wu.. CIONI
Laund...maIR
I--
Gre... Cuch Basins
SIDk
Wuer Softeners
Sump Pump" Ejectors
Wuer Reuen
Sanitary Bubblers
Bu and Soda Wasles
Show.. BUbs
UriDa1a
Floor Doabll
Laundrr Tubs
Denial Cuspidors
Service Sinks
~:~:.................._..............Oulside :£~:;~..=~~~..=~~::.:::=.:: Fee Verified. Receipled and Recorded R~ei:3,--~~~.~.S::e:n;,:lIon FOOl
.............-..........--.....-...........-........In.lde -=-:.........PIbg. Foo.
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In tho 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
.ubmit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
ersigned that no other uses will be made of the above connections..except as hereinafter
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