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I Lot No. moo ... ... .... . 1.1I10ck I Ward I Addition or Replat
J Dale
OUTSIDE WORK
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NIW SEW" WATER STORMS FEES FEES RELAY S. SEWER WATE' STORMS FEES
From MaiD to Curb Seplic Tanks From Main 10 Curb
FJom Curb 10 BIIUdIng ¿¡ 'f 1".' /'.C ~ Electric Pumps From Curb 10 Building
Repair
INSIDE WORK
NO. NEW UP. USED FlES NO. NEYI REV. ""0 ms NO. NEW REP. "SEO FEES
- - - -
BaIb Tub Garbaga DiIpoEala - C...tch Basm.
-
Wub Buin Dishwashers - Conduclors
- - -
Waler Clooet Laundr- Grease Calch Buw
SInIc Water Softeners Sump Pump lit Ejectors
Waler Healers SODÜuy Bubblers Bar and Soda Wasles
Shower .BaIbs Uriwlls
Floor Drains Dental Cuspidors
Laundry Tubs Service Sinks
Inspeetlons Valuation of Iho Work Herein Described Fee Vorüiod. Receipled and Rocorded Received Permit and Inspection Fees
------.......-......--...OutIide $...;1.¿;-'¿L._~...._.__.._._................- ....._~~..:.~....Sewer Fees
-...----..---_-..-.-Inside ...._...L.~_PIbg. Fee.
=-7d;:Z)s:- --~1DaI 0; $....--........-........-.---................-.....-.....-- _..._.-¥-.~-TOlal
$.-.-..............-.-....-..............-.....--.-.- """"'."."'..".""'ë.,¡:¡t;e..ü;;;-".'-"""-"-.'" Date /ò .,.;:f?, 7<5 -
In th. psrformanc. of this work th. und.rsigned owner (or hi. authorl..d agent) of s.id premises and his authorized Plumber hereby agree to be bound.n by and
submit to all statutes, city ordinanc.s. and rules and reguiatlons preo..ibe<l by Ihe lIoard of Public Works for the government of Plumb.rs.
It is futh., agreed by tho underslgnltd that no other uses will b. made of the above connections except as hereinaftor lisled.
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