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I Lot No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Dllie
NEW SEWEll WA'ER S10RMS fEES fE" RELAY S. SEWER WAtER S10RMS fEES
From MaIn to Curb Seplic Tanks From Main 10 Curb
From Curb to Building Eleclric Pumps From Curb to Building
Repair
INSIDE WORK
110.
NEW
USED
NO.
NEW
REP. I USED
NO.
NEW
REP- I USED
fEES
fEES
RIP-
flES
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Inspactions Valualion of Ihe Work Herein Described Fee Verified. Reoe- - - --- - - . - ---
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In the perlormance of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumb~bY agrae' to b3boun.ien by and
submit to all stalules, city "ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers-
e undersigned that no olher uses will be made of the above connections excepl as hereinafter lisled.
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_Tub
Garbage Dl8pooals
Catch Bow
Wuh Buin
Dlshwoh...
Conduclors
Greue Cllich Bow
Wilier Clooet
Laundrarnau
Wilier Softeners
Sump Pump" Ejectors
SIDk
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Bar and Soda Wasles
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WllJer Hellie..
Sanitary Bubblers
Shower Baths
Urinale
Floor DraIDa
Denial Cuspido..
I
Laundry TubII
Sernce Sinks
alualion of Ihe _W,,!-k Herein Described
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