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L~otHO' I Block I Ward I Addition or Replat
OUTSIDE WORK
Dale
NEW SEW'" WAtER S'ORMS lEES lEES RElAY S. SEWER WATER S'ORMS fEES
From Main 10 Curb Seplic Tanks From Main 10 Curb
FIom Cwrb to BullcUng yN 3.ðÒ Eledric Pumps From Curb 10 BuUCÜJlg
Repair
INSIDE WORK
NO. NEW RIP. USED flES NO. NEW REP. USE. "'S NO. NEW REP. USED fEES
- -
1!IaIh Tub Gæbag.. Dio¡>osaIs Calch Bulwl
Wash Buill Dishwashen Condudo..
- - - - -
Wale Cl_1 Laund:<- Gre..... Catch Buiwl
SiDk Waler Soft"..... Sump Pump Be Ejeclo..
Wale Healen Sanilary Bubblen Bæ and Soda Wastes
Showe .BaIhe Urinals
FlOO1' ~.. Denial Cuspidon
Laundry Tubs SerYlce Sinks
lnopectiono Valuation of Ihe Work Hereill Described Fee Verified. Receipled and Recorded Received PermU and Inspeclion Fees
---.---..--..--------.----..OuiIide $ -----_Zf>.--!?_.:.---_9-_--i2-----------....-- --_-?_=--~-_?_----Sewer Fees
--...-------.-------.----.Inlide ___m___...._---_.Plbg. Fees
-4p.~-=-- -;~ 0; $...--------------------------...---...--...----- ~ dO
-------"'------------"'CliĊ¸-i;;;.~;ë;-----"'--"'--------- --------'-----------Tofal
$-------------------------------------- Dale /.;)-~~:;)hs
In the performance of this work the undersigned owner (or his authorized age.ot) of said premises 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 Plumbe,s.
It Is futher agreed by the undersigned that no ..thor uses will be made of the above connections except os herelnaner listed.
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