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I Lol No. I BlOCk- I Ward I Addition or Replat
OUTSIDE WORK
N-
of
Plumber
Dat.
1705
...._-....--...._-
NEW SEWn WATER S'ORMS 'EES FEES RELAY S. SEWER WATER STORMS FEES
From MaIn to ClUb Septic Tanks From Main to Curb
From ClUb to BuUcllnsr ./ ",,/ --/'CO Electric Pumps From ClUb to BuUding
Repair
NO.
Batb Tub
Wuh Buin
Water CI_t
SIú:
Water H.at...
/
Shower BUbI
noor DrIllDa
Laundry Tubs
~.:"2i~~L._.---Outside
u.æ.._........9/-~¥2K........__Inside
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INSIDE WORK
NEW
UP. I USED I FlES I NO.
'EES
NEW
REP. I USED
FEES
NO.
NEW
REP.
USED
Garbage Dis~
Catch BuiDs
Dishwuhars
Conductors
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f--
I
Laundramats
Grease Catch BuiDs
Water Softeners
Sump Pump 8< Ejectors
Sanitary Bubblers
Bar and Soda Wutes
Urinals
,/
J/'
Dental Cuspidors
Service Sinks
~ValUatiOn of the Work Herein Described
I ~~-=-~=~~
Fee Verified, Receipted and Recorded
Received Permit and Inspection Faes
-----~:--~"".---.Sewer F...
--"".=-- j ...;~7;?~ ....
agent) of said premises and his authori.ed Plumbor heroby agre~ to be boundon by end
In the 'performance of this work the undersigned owner (or his authori.ed
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 ,,",enlgned that no other uses will be made of the abovo connoetions except as hereinalter listed.
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