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I Lot No. I Block I Ward~m__J Addition or Replal
OUTSIDE WORK
:lfame
of
Plumber
Dale
NEW SEW" WATER STORMS fEES FEES RELAY S. SEWER WATER STORMS fEES
Fzom MeIn to Curb Seplic Tanks From Main to Curb
""'m Curb to BuUcling Electric Pumps From Curb to Building
Repair
Received PermU and Inspection F...
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INSIDE WORK
NO.
NEW
"P.
NO.
NEW
REP. I USED
fEES
NEW
NO.
USED
FI.S
BaIh Tub
Garbage Dia~
Catch Basins
Wash Basin
Diahwashe..
Conducto..
Waler CI_t
Laundremals
Greue Calch Basins
Sink
Waler Softene..
Sump Pump 8< Ejectors
-
I
I / -----
sanUary Bubble..
Bar end Soda Wastes
1/'
Waler Heale..
Shower Baths
Urinals
1-
Floor Dreins
Dental Cuspido..
Laundry Tubs
Service Sinks
Inspections uuu._u------.Oulside j
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Valualion of ~ Work Herein Described
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Fee Verified, Receipted and Recorded
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R...I USED
FI"
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In the performance of this work the undersigned owner (or his authorired agent) of said premises and his authorized Plumber hereby agree to be bounden by end
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 the un¡le lsigned that no other uses will be made of the above connections except as hereinafter listed.
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