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I Lot No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Date
NEW SEWEa WATER STORMS FEES FIlS RElAY S. SEWER WATER srORMS FEES
From MaIn 10 Curb Septic Tanks From Main 10 Curb
From Curb 10 Building Electric Pumps From Curb 10 Building / /~æ)
Repair
INSIDE WORK
NO. NEW RIP. USEO FIlS NO. NEW RIP. USED FIlS NO. NEW RIP. USED FIlS
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BaIb Tub Garbage DiapooaJo Calch BulDs
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Wash Buin Diabwuhen Conductors
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Water CICIOI Laundr- Graue Catch BuIDs
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Sink Water Softeners Sump Pump Be Ejectors
Waler Heaten Sanitary Bubblers Bar and Soda Wasles
Shower Baths UriDa1s
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Floor DraIDs Denial Cuspidors --
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Laundry Tubs Senica Sinks
Inspedions Valuation of Ihe Work Herein Described Fee Verified. Receipted and Recorded Received Permit and Inspecllon Fees
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submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
signed thet no other uses will bl}. made of the above connections except as hereinafter listed.
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