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PLUMBING PERMIT - O~~kosh, Wisconsin Permit N~ 8568
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I Lot No. In JlI~___-_1 Ward - _____1 Add~ion or Replat
DII!8
OUTSIDE WORK
NEW SEWER WATER STORMS FEES ms R"AY S. SEWER WATER STORMS FEES
Fmm Ma;n 10 Curb zllf # L/~ Seplic Tanks From Main 10 Curb
!'»om Curb io BuIlcl1nø Elecuic Pumps From Curb 10 Building
Repair
INSIDE WORK
NO. NEW UP. USED FlES NO. NEW REP. USED FE" NO. NEW REP. USED FEES
f--- ~ - - -
Bath Tub Garbage DiIpoaabo Cafcb Bum.
Wuh BIIIÙ1 Dishwuh.... Conductors
Waf... CI....t Laun<lrllJlftllb Gre..... Cafcb BIII1ns
Sink Wafer Softeners Sump Pump 8< Ejectors
WilUr Hea1ers Sanitary BuDblors Bar and Soda Wasles
Sho...... .Ba1hs Urilla1s
FlOCO' Dralwl Dental Cuspidors
Laun<!zy Tubs Service Sinb
IlISpeetiollS Valuafion of the Work Herein Described Fee Verified. Receipted and Recorded R~ived Permit and Inspection Fees
3::J.Q~ .,36-<J
------------- ____d. ----- Outside _... --.::v-------Sewer Fees
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--.-.-.--.----__.._-Inslde ~-'~r--._PIbg. Fees
$--..--..--..-.-____..m..___.._m.._.._.-----.-..-- _..~_..--.--Total
=JJilj?-. ._;~ 0; $.m.-.------...........-.........-..----..----- -.......-.....--m'ëïtŸ'T;e..-û;e,""-"---.'-'-"---' Dafe 9-/6-/.5
In th. parlo,mance of this work th. undersigned owner (or hi. authorized agent) of ..id preml..s and his authorized Plumber herehy agree to be bounden by and
submit to all statutes, 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 that no other uses will be ",ad. of the above connections except as hol.einafter listed.
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