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I Lot No. I Block I Ward _n I AddUion or Repl81
OUTSIDE WORK
Dale
NIW SEwn WATER STORMS FEES FEES .ELAY S. SEWE. WATE. STORMS 'EES
From Main to Curb V" ~ ,I Septic Tanks From Main 10 Curb
From Curb to Bundln" ,.../ <../' (IV Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
NEW
RI,.
NO.
NEW
FEES
NEW
'EES
.E,.
USE.
NO.
.E,. I USE.
USED
"ES
BaIb Tub
Garbage Di8ponJo
Caleb Bulns
I---
Wuh Basin
Dishwashers
Conduclors
Waler Cl_t
Laundramals
Grease Calch Basins
f--
SIzIk
Waler Softeners
Sump Pump Ik Ejeclors
Waler Heale..
Sanitary Bubblers
Bar and Soda Wasles
Shower Balbo
Urinals
Floor DraIDs
Dental Cuspidors
Laundry Tube
Service Sinks
~:~:_:_-_._-----_n__m__m__mOulside J :~2Mf_~~r_:n:::::_::::_:: Fee Verified. Receipled and Recorded R~:i~:~~~r_S:'::e~n;':lIon Fees
=~7¡47~~~~:~ - :-_:n-:::::::::::::::::::::::--:-::::-:::=:::::~::::~:::_::::~::~::~ ------___--_në-'~-T;.¡;~;.;--______m_________mn. J D~I::~~';~ ?
In' the perlormanca of this work the undersigned owner (or his authorized agent) of said premises and his authorired 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 I. futher agreed by the un.sl,!"slgned that no other uses will be maJlp of the above connections except as hereinalter listed.
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Plumbo, --