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, PLUMBING PERMIT - ~jlhkosh, Wisconsin Permit N~ 8607
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I Lot Ko. ' I Block I Ward I Addmon or Replat
OUTSIDE WORK
Dale
NEW SEWEll WATER STORMS /, fEES FEES RElAY S- SEWER WATER STORMS feES
From Main to Curb -</1/ f! .,.:V Seplic Tanks From Main 10 Curb
From Curb So BuDding Eleclric Pumps From Curb 10 Building
Repair
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INSIDE WORK
NO- NEW RIP. USED flES NO. NEW RE'. USED fEES NO. NEW RE.. USED fEES
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Batb Tub Garbage Dispueals Catcb RasIwI
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Wuh Buln Dishwashen - Conductors
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waSor Cl- Laundr- Greasa Crdcb Bulne
SInk Watar Softeners Sump Pump 8< Ejeciors
Water Heaters Sanitary Bubblers Bar and-Soda Wastes
8ho.... Batbe Urinals
FloĊ Dralu Deniel Cuspidors
I.e._dry TubIi Servloa Sinks
IJISpactlnJlS Valuation of the Work Herein Described Fee Verified. Receipled and Recorded Received Permit and Inspeclion Fees
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--..--.----------.-.---OuIaIde $.---------- .l.l.o9::t2. ...-. -______0_-__--------- -Z----_.___.sewer Fees
---------------__.-_--Inaide -- j._~----'plbg. Fees
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In Ih.. performance of this work the undersigned owner (or his authori.ed agent) of .aid premi... a"d his authorized Plumber hereby agree to be bounden by and
submit to all .talutes, city ordinances, and rules and reguiations prescribed by Ih. Soard of Public Works for the govornmont of Plumbers.
It I. futher agreed by the undersigned that no Gther use. will be made of the above conn.ctions except a. he.einafl.r ¡¡sled.
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