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LL~"LN~O'-- I Block I Ward I J\.dditJ~on~or Replat
Dale
OUTSIDE WORK
NEW SEWD WATER STORMS lEES lEES RE!AY S. SEWER I WATER STORMS lEES
From Main to Curb Seplic Tanks From Main 10 Curb
From Curb to BIII1cIInø Eleclric Pumps F.om Curb 10 Building
Repm
INSIDE WORK
NO.
REP.
NEW
USED
IIŒS
110.
NEW
REP. I USED
FEES
NO.
NEW
REP.
USED
FEES
Bath Tub
I
7
17
~
~
Grease Calch Baølns
Garbage Dilpoeak
Caioh Baølns
Waøh BIIIÚI
Dilhwaøheu
Condudors
I~-'-
-,-
Walft CI_t
Lauwamalll
8II1II:
Wale. Sofle....rs
Sump Pump S. Ejeclors
Wah~ Heaters
Show... .BaIbs
Sanitary Bubblers
Urinals
Bar and Soda Wasles
Floor Ðr&lins
Laundry Tubo
Denle! Cuspidors
Senioe Sinks
~:~:-_------------____Ou~de 1;'~~ô::_:~~~~::__::~~~ D::=:~ Fee Verified. Receipled and Recorded R~~;~~~~e;ns::ion Fees
~~~~3?f£!?l ~~ns~ $-----------------------------------------------.--- -~-_....._"...._..--C;¡;¡Trëâi~;ë;.._...__._--_..__._:r.-J.tr;~=:: Fee.
-t;;J; . 79; "ineI OK ,$._--------_...._--_......~_.._- , Dale :¿ . V2Y
In the performance of this work the undersigned owner (or hi. authorized agont) of said premls.s and his authorized Plumber hereby agree 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 PI"mbers.~
It Is futher agreed by the undersigned that no other uses will be med. of the above conneotions except .. herelnaner listed.
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