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I Lol Ho. I Block I Ward , Addition or Replat
OUTSIDE WORK
Date
NEW SEWE. WATEr STOIMS FEES FEES .ELAY S,SEWE. WATE. STOIMS FEES
From MaIn 10 Curb Seplic Tank. From Main to Curb
From Curb 10 Bulldlnll Electric Pumpa From Curb to Building
Repair
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INSIDE WORK
NO.
NEW I lIP. I USED I FIlS I NO,
.EP. I USE.
NEW
.'P. I USE.
FEES
NO.
NEW
FEES
Bath Tub
Garbage DÎI~
Catch Buw
Wash BulD
Dishwub....
Conducto..
Wat.. Cl_1
LaundrlllnÙl
Greue Catch BulDa
Slak
r--
Water Softeners
Sump Pump" Ejectors
Water Heate..
Show.. BatbSI
sanUary Bubblers
Urinals
Bar and Soda Waste.
Floor Dralu
Loundry Tuba
Denial Cuspido..
Service Sinks
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Valuation of tbe Work Herein Described
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Fee Verified. Receipted and Recorded
Received Permit and Inspection F...
.....".""......""."...Sower F...
....".¿'.@...."Plbg. F..s
.""....j.<.f2Q.....Total
Date ;ß--'tP - ?r
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...
In the 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
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It is futher agreed by theAundersigned that no other uses will be made of the above connections except as herei
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