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Dale I Lol No. b I Ward I Addition or Replal
OUTSIDE WORK
-
NOW SEWn WATER STORMS FEES FEES RELAY S. SEWER WATER STORMS FEES
From Main 10 C\U'b Seplic Tanks From Main 10 Curb
~m C\U'b 10 BuDding Eleclrlc Pumps From C\U'b 10 Building
Repair
INSIDE WORK
NO.
NEW
RIP.
FEES
USED
NO.
NEW
REP. I USED
FEES
"0.
FEES
"OW
REP.
USED
Beth Tub
Garbage Dia~
Diabwuben
Conductors
Caleb Bulns
Wuh Buin
Waler CI_t
LaundrlUl1lWi
I-
Greua Caleb Bulns
SIIIk
Waler Sofleners
I
Sump Pump" Ejectors
Waler Heale..
Sanitary Bubblers
Urinals
Ber and Soda Wules
Shewer Baths
"cor Dralu
Le""dry Tube
Denial Cuspidors
Service Sinks
IDlpscIioDl ......--------Oulside
~:~::::=:::~-:::~~::=::::::~~::=_.._______ooIDlide
Valualion of Ibe Work Herein Described
$.t£..?c:i._::1_oo____._-------------------------.---
$.00----00-----_-----------------"------___--_00---_____.----------'-'
$_--__00----------__------_----------00_---------__00__--------_------
---'------ë-';;ïT,ë¡;~,ë;-----------'-------------
Fee Verified. Receipled and Recorded
Received Permit and Inspeelion Fe..
----oo----oooo--oo.-----Sewer F...
---------L_:~--plbg. Fees
-------_..!.._--~'::?.--Tolal
Dale ;g /y'" 7'
----------------------.---FiDal OK
In the performanca of this work the undersigned owner (or his authorlred agent) of said premises and his authorired Plumber hereby agrae to be bounden by ond
submit to ell statutes, city ordinances, and rules and regulations prescribed by the Boord of Public Works for the government of Plumbers.
It Is luther agreed by the undersigned that no othar uses will be mede of the above connactio!)s.
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