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Date
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LoNoo ' 7 ' I Block I Ward I Addition or Repl"!
OUTSIDE WORK
NEW SEWn WAIER STORMS fEES fEES RELAV S, SEWER I WAlE. STORMS fEES
From MelD to CW'b Septic Tanks From Main 10 Curb
1-
~m ClUb to Building Electric Pumps From Curb 10 Building
~ --- 3H
Repair
INSIDE WORK
110, NEW UP, USED flES NO, NE'" REP, USE. ...5 NO- NEW REP- USE. 'EES
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Batb Tub Garbage DIspooo1a Catch Basins
Wasb BasiD Dishwashers - Conductors
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W- CI_I Laundr- Gre... Catch Basins
SIIIII: Water Softeners Sump Pump 8< Ejec!ors
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Water Heaters Sanitary Babble.. Bar and Soda Waste.
aha..... .Batbs Urinals
n....... Drains Dental Cuspidors
Laundry Tnbs Service SiDb
Inspeclions Value!ion of the Work HereiD De.cribed Fee Verified. Receipted and Recorded Received Per~ and Inspection Fees
-------------------------Oubida $----~~--.,2:J:.--~--------------------- ----""'~":_~-----Sawer Fees
------------------wide ----------~lbgo Fee.
=-7/J13-i: -~~ 0; $----------------------------------------------------- ______3 ~---Tolal
$--------------------...--------------------------- "'---------------------ëïtŸ-ÿ;;;,~;ë;----------------- Date 7- 7- ?-.S
In the psrformance of this work the undersigned owner (or hi. authorized agent) of .aid premises and his authorized Plumber hereby agree to be bounden by and
submit to all statutes, city ordinanc.s. and rules and regulations prescribed by the Board of Public Works for the governmant of Plumbers.
It Is futher agreed by the undersigned that no other uses will bo made of the above connections except as herainaner listed.
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------------ ---- PlumbIng In'pector --2.) -.8 ,
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