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I I Block I Ward I AddiUon or Replat
Lot No.
OUTSIDE WORK
Dille
--
NEW SEWEi WA"R STORMS fEES ms RSLAY S. SEWER WATER STORMS fEES
From MaiD to Curb Seplic Tanks From Main to Curb
From Curb to DuDding Electzic Pumpa From Curb to Building
Repair
INSIDE WORK
NO. NEW UP. USIID flES NO. NEW REP. USED FEES NO. NEW REP. USED flES
¡---- - - -
BaIb Tub Garbage DiIpooaIs CIi!ch B..!WI
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Wuh Duin > /:',60 Dlshwashen Conduclors
I 1- - - - -
wa- Cl....t y :'¿°é Laundr- Gre.... C!Ùch Ba!WI
Slak Wilier Softeners Sump Pump 8< Ejectors
Waler Helllers Sanitary Bubblers Bar and Soda Wasles
Shower .Baths Urinals
Floor DrIlÚUl Denial Cuspidors
Laundry Tubs Service Sinks
JIISpaeIions ~at¡on of tit.. Work Herein Described Fee Verified. Receipled and Recorded Received Permit and Jnspeclion Fees
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In the performance of this work the undersigned owner (or his authori.ed agent) of said premises and his authorized Plumber hereby agree 10 be bounden by and
submit to all statutes, city ordinanc... and ru"os and regulations prescribed by the lIoard of Public Works for the government 01 Plumbers.
I! is futher agreed by Ihe undersigned that no other uses will be ",ade of the above connections except as hareinstter listed.
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