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I Lot No. I Block I Ward I AddUion or Repla!
OUTSIDE WORK
Dale
Nnw SEwn WA"R STORMS lEES FEES RELAY S. SEWER WATER STORMS lEES
F...... MaIn to Curb Septic Tanka From Main to Curb
From Curb to BuDding Electric Pumps From Curb to Building
Repair
Received Permit and Inspecllon Fe..
nn.n..mnnmnSewer F...
....j::::~::::; Fee.
7? J. 76
INSIDE WORK
NO.
NEW
UP.
NO.
NEW
REP. I USED
FEES
NO.
USED
lEES
Batb Tub
Garbage Dispooals
Dishwashers
Catch Basw
Wuh Basin
Conductors
Walu CI_t
Leundramall
Gre... Catch Baslna
SInIo:
Water Softeners
Sump Pump iii: Ejectors
Water Heaten
I
Sanitary Bubblers
Bar end Soda Wastes
I / trC-
Shower Baths
Urlnols
FIoĊ Drains
Dental Cuspidors
Laundry TuhII
Service Sinks
Valuallon of the Work Herein Described
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Fee Verified, Receipted and Recorded
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Date
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$ mm"" nmmmm' .... mm nnnm.n' "_n._......mm_.-
NEW
REP.
FEES
USED
I--
In the performance of Ihis work Iha undersigned owner (or his aulhorized agenl) of said premises and his authori.ed Plumber hereby agree to be bounden by and
submil 10 all statulas, city ordinances, and rules and regulations prescribed by the Board of Public Works for the government of Plumbers.
It Is futher agreed by the undersigned Ihat no other uses will be made of the above connections excepl as hereinafter lisled.
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