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! Lot No.
I Block __I Ward
I Addüion or Replat
DÙ8
OUTSIDE WORK
NEW SEWEI WA'EI ",ORMS FEES FEES RELAY S. SEWER WA'ER ",ORMS FEES
From MaIn to CW'b Septic Tanks From Main to CW'b
him CW'b to BWlding Electric Pumps From CW'b to Building
Repair
INSIDE WORK
NO. NEW IE,. USED HES NO. NEW RIP. USED FEES NO. NEW RIP. USID FEES
_Tub Garbage D~ Catch BasinR
,/ - -
/ Wash Basin 1/,Dr> Dishwashers Conduclon
- -
/ Wa!8r Cl_t ¡/ I I, o¡:; LaundramIIÙ Greue Catch BasinR
,/ . I---
I Sink II,UD Water Softenen Sump Pump" Ejeclon
7:;- WÙ8r Heate.. Sanitary Bubblen Bar and Soda Wasles
/ Shower Bathe ,./ 1/( d7i Urinals
Floor Dra1D8 Denial Cuspldo..
Laundry Tubs Service SInD
Inspec:lions :Î:;~~~__=:r::_::::_:: Fee Verified, Recelpled and Recorded Received Perml! and Inspecllon Fees
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------------------------Final OK $------------------------------------------------------------------------ -------c,¡;,T;e.;;-;;ë;------------------------ Date ~.~7
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submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers,
It I. futher agreed by the undersigned that no other use. will be made of the above connections except a. hereinafter listed,
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