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I Lot No. I Block I Ward I Addilion or Replat
OUTSIDE WORK
Date
NEW SEwn WATE. STORMS FEES FEES .ElAY S. SEWE' WATE' STORMS FEES
Fzom MaIn 10 ClUb Seplic Tanks From Main 10 Curb
FIom ClUb 10 Building Electric Pumps From Curb 10 BuUding V /,.¿'JO
Repair
INSIDE WORK
NO.
NEW
"P.
NO.
NEW
'EP. I USE.
NO.
fEES
NEW
'EP.
USE.
FEES
USED
FlES
_Tub
Garbage Dls~
Catch Basins
Wub Basin
Dishwashers
Conductors
I~-
WaiN CI0881
LaundrlUlUlbl
Greue Catch Basins
+--
SiDk
Water Softeners
Sump Pump 8< Ejectors
Water Heaten
Sanitary Bubblers
UriDals
Bar and Soda Wastes
ShOWN Balbi
~-+-
Floor Dr8iD8
Dental Cuspldon
Laundry Tubo
Service Sinks
IJllP8CÜons Valualion of the Work Herein Described Fee Verified. Receipted and Recorded Received Permit and Inspection Fees
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In the psrlormanca of this work tho undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by and
submit to all statutes, city ordinances, and rules and regulations prescribad by the Board of Public Works for the government of Plumbers.
It Is futher agreed)y the undarsigned that no other uses will be mede of the above connections axcept as hereindtar listed.
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