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i PLUMBING PER~HT - Oshkosh, Wisconsin Permil N~ 9139
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I Block I Ward
OUTSIDE WORK
I Lot No.
[ Addilion or aeplat
Dùe
NEW SEwn WAtER STORMS FEES lEES RELAY S. SEWER WAtER STORMS FEES
From M8in 10 C...b Septic Tanks From Main 10 Curb
From C...b to BuDding Electric Pumps From C...b 10 Building
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INSIDE WORK
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NO.
NEW
UP.
NO.
NEW
REP. I USED
NO.
NEW
fEES
REP.
USED
lEES
USED
flES
Ba!b Tub
Garbage Disposah
Ca!cb Bulna
Wub Buin
Dishwuhers
Conductors
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Wùer CI_I
Laundrl1ll>ÙR
Grease Cùch Buins
SIJIIo:
Wùer Sofleners
Sump Pump" Ejectors
Wa!er Heùen
Sanitary Bubblers
Bar and Soda Wules
Shower Ba!hs
Urinals
"oar Dr8IDs
Laundry Tubs
Denial Cuspidors
Service Sinks
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Valuation of the Work Herein Described
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$............................................................................
$..........................................................................-
Fee Verified. Receipled and Recorded
Received Permit and Inspection F...
.......j;..:"::?..Sewer Fees
.. ..................PIbg. Fees
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Date ¿I 6-;7 ¿:,
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In the performance of this work the undersigned owner (or hi. authorized agent) of .aid preml... 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 Plumbers.
It I. futher agreed by the undersigned that no other uses will be made of the above connections except as hereinafter listed.
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