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LL_o1NO. I Block I Ward' Add;;;o" or Replat
OUTSIDE WORK
Date
NEW SEW" WATER STORMS 'EES 'EES RE'AY S. "WE. WATE. STORMS 'EES
From MaID to Curb Septic Tanks From Main to Curb
FI<>m Curb to BuDding Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO.
NEW
REP.
USEe
FlES
NO.
"'EW
REP. I USE.
'EES
NO.
NEW
REP. I USID
FEES
-,-
Bath Tub
Garbage DIsPDAIs
Catch Basins
,-
Wub Buin
Dlshwuhers
Conductors
,-,-
Wat. CIONt
LaundrMOats
Greue Catch Buins
SIIIII:
J I~ )X~
Sump Pump 8£ Ejeclors
Water Softener.
Watw Heelers
Show... Baths
Sanitary Bubblers
Urinals
Bar and Soda Wutes
Floor »raIDs
Laundry Tubs
Dental Cuspidors
Service Sinks
~~:"_..__._--_.___Outside 2t~2£_:~..~~:~.::::_~:::~ Fee Vermed. Receipted and Recorded R;~:_~.;:~~~e:i-iOD Fees
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In the performance of this work the undersigned owner (or hi. authorized agent) of ..id premi.e. and his authorized Plumber hereby agree to be bounden by end
submit to all statutes. city ordinances. and rule. and regulations pr.scribed by the Board of Public Works for the government of Plumbers.
It i. futher agreed by tha undarslgned that no other uses will be mede of the above c.~nections exoept as hereinaftar listed.
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