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I Lo.t No. I Block I Ward I Addition or Replat
Date
OUTSIDE WORK
NEW SEW" WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn to Curb Septic Tanks From Main to Curb
hom Curb to BuDding Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO.
NEW
....
NO.
REP. I USED
FEES
FEES
NO.
NEW
RE.. I USED
NEW
USED
FRES
IIatb Tub
Gubage Dispon!s
Dishwashers
Catch BasÙII
L
I
,/
/'
jL
/--
r--
Wub Basin
Conductors
G~- Catch BUÙII
LaundrlUDllbl
Watu CI_t
Sink
Wate~ Softeners
Sump Pump II< Ejectors
Wate~ Heaters
sanUuy Bubblers
Bu and Soda Wastes
Showu BathR
Urinals
n~ Dralu
Dental Cuspidors
Launlhy Tubs
Service Sinks
~~'.~ j ~~'_H~=~ F~ v.=:~= ~~~]Ji= '-
I~ the performance of this work the undersigned DViRer (or his authori.ed agent) of said premises ;~d-¡;¡;-~-;;th~~¡~ed Plumber hereby agree to í,e 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.