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I Lot No. I Block I Ward
OUTSIDE WORK
Date
I Addition or Replat
NEW SlWEI WATER STORMS FEES FEES RElAY S- SEWER WATER STORMS FEES
From MaIn to Cub Septic Tanks From Main to Curb
From Cub to BuDding Electric Pumps From Curb to Building
Repair
INSIDE WORK
110- NEW UP- USED FI" NO- NEW REP- USED FEES "0- NEW REP- USED FEES
-
Bath Tub Garbage Diapooa]a Catch BulDa
+----
Wuh Bum Dlshwuhen - Conductors
~ -
WatN CI_t Laundramab Greue Catch BulDa
-
SIDk Water Softeners Sump Pump Ik Ejectors
I Wate~ Raaten v/ /'dð Sanitary Bubblers Bar and Soda Wules
ShoWN Batba Urillals
I'1ocn- Dra1Ds Denial Cuspidors
Laundry Tube Service 5mb
IDlP8dlons :di~:~:__::~::_:::=_:: Fee Verified. Receipted and Recorded Received Permit and Inspection F....
-------------------------------------_----Oullide ----------------------------Sawer F...
------------------------------------------------------Inside --j~--QP..--------_PIbg. Fees
----------------------------------------------- $------------------------------------------------------------------------ j.c_f!!2_----______Total
-------------------------Final OK $------------------------------------------------------------------------ --------------------------C"i¡Y-T;;;.~;ë;------------------------- Date :7~3h:7
In the performanca of this work the undersigned owner (or his authorized agent) of slid premIses and his authorized Plumber hereby agrae 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 Is futher agreed by the undersigned that no other uses will be made of the above connections except as hereinaner listed.
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