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L~o.. I~ I Ward I Addüion or Replat
OUTSIDE WORK
NEW SEWEI WATEI STORMS lEES lEES RELAY S. SEWER WATER STORMS FEES
From MaID to Curb Septic Tanks From Main 10 Curb
From eii.b to Building Electric Pumps From Curb 10 BuUding
Rapair
NO. NEW UfO. USED FlES NO. NEW REP. USED lEES NO. NEW RIP. USID flU
I-- - - -
Bath Tub GarbagaD~ Catch Basins
-
Wuh BuID Dishwashers Conductors
1- - - - -
Watar CIoIeI Laundramats Greue Catch BuiDs
SbIk Water Softeners Sump Pump" Ejectors
Watar Huten ( II K/ S&nÜary Bubblers Bar and Soda Wutes
8ho.... Baths Urillals
Floor :D%aiDs Denial Culpidon
LaUlldry Tubs Service SlDks
IMpactiOns ValuatIon of the Work HerelD Delcribed Fee VerWed. Receipled and Recorded Received Permü and Inspaclion F-
...-..-.......----....__......mm..m.-OuÞIde $...mL':1t2.:...~................._.._.................... ::::=:::T::~::::: F":
..m.- """'m"" ...... m --.....- ....-...--lnside
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---.-.-..-.-....-........---FûIal OR: $......................................................................-.... Date ~ ..s;:-. ttb
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Data
INSIDE WORK
In the performance of this work the undersigned own,er (or hi. authorized agent) of .aid preml.e. and hi. authorized Plumber heraby agrea to be bounden by and
submit to all statutes, city ordinancel, and rules and regulations pre.crlbed by the Board of Public Work. for the government of Plumbers.
It Is futher agreed by the undersigned that no other uses will be made of the above connections excapt as hereInafter listed.
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