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Date
I Lo.I No.
r Block ¡ Ward
I Addition or Replat
OUTSIDE WORK
NEW SEwn WAIER STORMS FEES 'EES RELAY S- SEWER WA'ER STORMS "ES
From Me1n 10 C...h Seplic Tanks From Main 10 Curb
nom C...h 10 BuDding Eleclric Pumps From C...h 10 BuUding
Repair
3-'1
S
s
i]
:<.
INSIDE WORK
NO.
NEW
..,.
NEW
RE,. I USE. I~ES I NO.
la.."
NEW
'EES
RE,.
USE.
USED
NO.
Garhage DÙlposa1s
Dishwashers
LaundrlUDlds
Water Softeners
Sanitary Bubhlers
Urioels
Bar and Soda Walles
1.......-
¡,/J~
,/
Bath Tub
L
¡/
/
V
./
Calch Basins
12.,,0
b,a.
Wuh Basin
Conduclors
Grease Catch Basins
Water Clooel
~
;z
Sump Pump" Ejeclors
1/
Sink
Water Heaters
Shower Baths
Floor Dr8lu
Laundry Tubs
,/
b.pô
I~-~-
Denial Cuspidors
Senica Sinks
Inspections
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Valualion of Ihe Work Herein Described
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Fee Verified. Receipled and Recorded
.
Received Permil and Inspection Fees
--------------------------Sawer F-
_&?:2t_¿2Q---Plhg. Fees
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agent) ~--S~-I~--~~~:¡::~~a:~:;:;~~t~-:r-I~=--:Iumb~r he:::: a~~4~~nden by end
.
In the performence of this work the undersigned owner (or his authorized
submit to all statutes. city ordinences. and rules and reguletions prescribed by the Board of Public Works for the government of P_lumbers.
It Is futher agreed jw the undersigned thet no other uses will be made of the above connections except as hereinefter Ji' . /'
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