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l_Lc>i~ I Block I Ward I Addition or Replat
Date
OUTSIDE WORK
NOW SEW" WATER STORMS fEES FEES RElAY S. SEWER WATER STORMS FEES
From MaIn to Curb Seplic Tanks From Main to Curb
,....", Curb to BuDding Eleclric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO.
NEW
NO.
NEW
FEES
fEES
1<0.
NEW
REP.
USED
REP. I USED
IE,.
US"
TEES
Bath Tub
Garbage Dlopoaala
Catch BaslDs
Wub Basin
Dishwashen
Conduclors
WatN Cl_t
Laundramata
Greue Catch Basins
Sink
Water Softeners
Sump Pump II< Ejeclors
Water Heaters
/
liFt!
Sanitary Bubblers
Bar and Soda Wasles
ShOWN Bath8
UriDalo
noar Dralu
Denial Cuspidors
Laundry Tuba
Impactions
--"---------'-------------_d...-------__---..Outside
------------------.---..-------------..-------------Inside
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SerYiea Sinks
Fee Verified. Receipled and Recorded
Valualion of Ihe Work Herein Described
$-/%.(¿---~---"---------_____"d__"_---_-------
.
Received Permit and Inspecllon Fa..
---------..------------.----Sawor Fees
h:_::::-:¿~::~::; Faas
;r. :::J. /1(,.
------
-------------------------------------------...----...----.
City T,...ur..
Date
.
In tho performance of this work tho undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to ba bounden by and
submit to all statutes, city ordinances, and rules and regulations prescribed by the Board of Public Works for tho government of Plumbers.
II Is fulher agreed by the undersigned that no other uses will be made of tho above connections except as hereinaltar listed.
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