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I Lot No. I Block / I Ward I Addition or Replat
OUTSIDE WORK
Date
NEW SEWn WATER STORMS FE" FE" R"AY S. SEWER WATER STORMS FEES
From MaIn to Curb Septic Tanks From Main to Curb
FJom Curb to BuDdlng """,--- ~ 4,cxJ Electric Pumps From Curb to BuUding
Rapair
INSIDE WORK
110.
NEW
II'.
USED
FlES
NO.
NEW
RE,. I USEO
FlES
1<0.
NEW
RE'.
USED
FEES
Bath Tub
Garbage DiI~
Catch Bulns
¡-----
Wuh BulD
Dilbwuhen
Conductors
1-
Water Cloeet
Laundr-
Gre... Catch BulDs
f--
SIDk
Water Softeners
Sump Pump 8< Ejectors
Water Heaters
Sanitary Bubblars
Bar and Soda Wastes
Shower Baths
Urinals
noor DralDs
DeDtal Cuspidors
Laundry Tubs (
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Service SlDb
Valuation of the Work HereiD Described
$6J!:.?2_--~---------------_-__-_----------_-_--
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Fee Verified. Receipted and Recorded
Received Permit and InspaelioD Fees
--__:$LO:f:!---_Sewer Fees
--------l'--~-----_Plbg. F..s
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.,¡ the performance of this work tho undersigned ownor (or his authorirod agent) of said premises and his authorized Plumber hereby agreo to bo boundan by and
submit to all statutos, city ordinances, and rules and regulations prescribsd by the Board of Public Works for tho governmont of Plumbors.
nod that no othor usos will bo mode of tho above connoctions excopt as heroinafter listed.