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l Lot Ho.
I Block I Ward
I Addilion or Replai
Dale
OUTSIDE WORK
HI.. .E"E. "ATER STORM' FEES 'EES RELAY S. 'EWER WATER STORMS 'EE'
From MaIn to Curb II/) ðA" /I/(!ß¡, !N-/L,)^ Seplic Tanks From Main 10 Curb
From Curb to BuDding I / /
Eleclric Pumps From Curb to Building
Repair
I I
INSIDE WORK
NO.
NEW
UP.
NEW
'EES
'EES
NO.
NEW
REP.
USE.
USID
NO.
REP. I U'E.
FIlS
Bath Tub
Garbage Dilpolals
Calch BaslJ1a
1-
Wub Basin
Dilhwashen
Conduclors
Waler Cloeet
LaundrlUD&l8
Gre... Calch Basins
f--
Sink
Waler Softeners
Sump Pump 8< Ejeclors
Water Healen
Sanilary Bubblers
Urinail
Bar and Soda Wasles
Shower Baths
Floor Drains
Denial Cu_pidors
Laundry Tuho
~:~::_...._m....mm_--_._._.__.Ouilide
Service Sinks
Fee Verified, Recelpled and Recorded
Valuation of Ihe Work Herein De_crlbed
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Received Perml! and In_paellon Fe..
....$L<fJ2...._....Sewer Fees
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In the perform_nee of this work the undersigned owner (or his authorired agent) of said premises and his author ired Plumber hereby agree to be bounden by and
submit to all statutes, city ordinance_, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It Is futher agreed by the undersigned that no other uses will be mode of the above connections except. as hereinafter listed.
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