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I Lot No. I Block I Ward I Addilion or Replat
OUTSIDE WORK
Dale
NIW SlWEt WA"R STORMs FE" fEES R"AY S. SEWER WATER STORMS fEES
From MaIn to Curb Septic Tanks From Main to Curb
F>om Curb to BuUellng Electric Pumps From Curb to BuUellng
Repair
INSIDE WORK
NO.
NIW
USED
NO.
NEW
REP. I USED
NO.
fEES
RIP.
flES
BaIb Tub
I
I
I
I
I
I;. .--v
j.6{;
J. HJ
¡.o1J
.tJ-(J
Saniiuy Bubblers
Catch Basins
Garbage Disponls
Dishwashers
Conductors
Wash Basin
1/ t-ð
/
Grease Calch Basins
Sump Pump II< Ejectors
¿
f--
ford
Wal81' Clooet
Laundramats
SIDk
Waler Softeners
NEW
USED
FEES
REP.
Shower Baths
Urinals
Bar and Soda Wastes
Waler Healers
noor Dre1ns
I
11, tJ-C-
Denlel Cuspidors
Laundry Tubs
Service Sinks
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Velualion of the Work Herein Described
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Fee Verified. Receipted end Recorded
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Received Permit end Inspecllon Feeo
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.----.2l::...~.Totel
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Dale
In the performance of this work the undersigned owner (or his euthorired agent) of seid premises end his authorired Plumber hereby egree to be bounden by OlId
submit 10 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 made of the above connections ,!!,cept os hereinafter lii!'ed.
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Plumb.,