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I Lol No. I Block I Ward ~ I Addition or Replat
OUTSIDE WORK
x
Date
NIW SEW" WATER S'ORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn 10 Curb Seplic Tanks From Main 10 Curb
nom Curb 10 BuDding Elaclric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO. NEW RIP. US'" FIlS NO. NEW REP. USED FEES 110. IIEW REP. USED fEES
- ~ - -
BathTub Garbage Dilpon]a 1- Caleb Buins
-
Wash Buln Dilbwuhen Conduclo"
~ - -
Water CI_I Laundramals Gre... Catch Buins
Sink Water Soflen... Sump Pump" Ejeclo..
I W8I8r Heat.rs ./ ¡,~ Sanitary Bubblers Bar and Soda Wastes
Sho.... Baths Urinals
Floor Dralu Denial Cuspidors
Laundry Tubs Service Sinks
Inopaclions : j~~o~~: n::~: :~: ::=~=: Fee Verified. Receipled and Recorded Received Permil and Inspeclion Faeo
-- ~-~~--_. -~._~-----~--...-- ~ -~ ___h' _..---- ~ ~ ~ Outside ~~----_.-----....~~..n..-~.Sawer F...
~--~~------.__._-~.~~~--------.__.---~~------.._.---~-~-Inside n------l~~Ø!n---_PIbg. Fees
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gent) 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 luther agreed by the.-uJIdersigned that no other uses will be made of the above connections except as hereinafter listed.
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