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I Lot No. --I Block I / Ward I Addition or Rel'lal
OUTSIDE WORK
Date
NEW SEwn WATER S'ORMS fEES fEES RELAY S. SEWER WATER S'ORMS fEES
From MaIn 10 Curb Septic Tanks From Main 10 Curb
From Curb 10 Bundln!! Electric Pumps From Curb 10 Building
Repair
-l
INSIDE WORK
NO.
NEW
UP.
HES
NEW
REPo I USED
NO.
NEW
USED
fEES
REP.
fEES
USED
NO.
_Tub
Garbage Dlapooals
Caich Bulna
/
/
JL
/'
I/,ðo
~
f--
I. ðé.
Dlabwashers
I~~
Conduclors
Wub Basin
v
¡.tV
Gre... Catch Basw
LaundramaiJ
Water CI_I
Sink
Water Softenars
/
/
Sump Pump Ie Ejactors
I
./'
Sanitary Bubblers
Urinals
Bar and Soda Walles
1¡.ðÐ
Waior Heaters
Shower BaIIu
/
,/
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Denial Cuspidors
Floor DraIDa
Laundry Tube
Service Sinks
~:~::_.oo_m- nm-----------.--.Oulslde ValUatiOn~ Work Herein De:crihed Fee Verified. Recelpled and Recorded Rece.I::~n~:::_llo:'::e:ns=lon F-
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In the performance of this work the undersigned owner (or his authorizad agent) 01 said premises and his authorized Plumber hereby agrae to be bounden by end
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government 01 Plumbers.
It Is luther agreed by the undersigned that no other uses will be made of the above connections except as hereinalter listed.
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