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I Lot No. I Block I Ward I Addition or Replat
Date
OUTSIDE WORK
Naw SEWb WArb STORMS fEES FEES RELAY S. SEWER WATER StORMS fEES
From MaIn to Curb Seplic Tanks From Main 10 Curb
From Curb to BuDding Electric Pumpe From Curb to Building
Repair
INSIDE WORK
Batb Tub
NEW ISP. USED FlES NO.
V Garbage Diapooab
;../ Dlshwuhen
V LaundrameU
V Water Softeners
V Sanitary Bubblers
Urinals
--
vi 1(- Dental Cuspidors
REP. I USED
fEES
FEES
"O.
NEW
NEW
REP.
USED
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Catch Bulns
Conductors
Wuh BuiD
Sump Pump Be Ejectors
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c
Wllter CI_t
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Greue Catch BuiDs
SIDk
Water Hellte..
Bar and Soda Wutes
Shower Batha
noor Dr8lns
Laundry Tubs
Inspect1ol111
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Service SiDks
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Receiyed Permit and Inspecllon Fees
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Fee Verified. Receipted and Recorded
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In the performance of this work the undersigned owner (or his euthorized agent) of said premises and his authorized Plum
submit to ,all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the governJ»e1lfÕf
It is futher agreed by #la undersigned that no othr uses will be made of the above connections except as here;