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Date ~ _~___I Lot No. I "BlOCk I Ward I Addition or Replst
1626 6
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OUTSIDE WORK
NEW SEW" WATER STORMS 'EES 'EES RELAY S. SEWER WATER STORMS FEES
From MelD to Curb V'. .,...-/ J"", Septic Tanks From Main to Curb
FIom Curb to BuDding V- ---- Electric Pumps From Curb to Building
Rapair
INSIDE WORK
NO. NEW REP. USED FI" NO. NEW REP. USE' 'EES NO. NEW REP. USE' "ES
- - - -
BaJb Tub Garbage Diapooals CaJcb Buw
- - -
Wub Buin Dlshwuhers Conductors
- - - - -
WatN CI_t Lauudr- Greue Catch Buw
-
SIDk Water Softeners Sump Pump Be Ejeclors
Wa!u Heaters Sanitary Bubblers Bar and Soda Wastes
ShoWN Baths Urinals
noor 0.- Dental Cuspidors
Laundry Tubs Service Sinks
IaspedÏons :~o~...:..=:~::.::~:.:: Fee Verified, Receipted and Recorded Received Permit and Inspection Fees
--..............................-........-.............OulBide ~_.3'.~.....Sswer F...
"........~....-....................._.................Iaslde .._~~..._PIbg. F..s
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premises and his authorized Plumber hereby ag
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
undersigned that no other uses will be made of the above connections except as hereinafter listed.
by and