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I Lol No. I Block I Ward I Addition or Replat
OUTSIDE WORK
Data
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NEW SEwn WATER STORMS FEES FEES RELAY S, SEWER WATER STORMS fEES
From MaIn to Curb Seplic Tanks From Main to Curb
!\rom Curb to BuDding .Lj'¡J---' It/~ ~ Electric Pumps From Curb to Building
Repair
INSIDE WORK
NO,
NEW
REP,
fEES
USED
NO,
FEES
NEW
REP, I USED
FEES
"0,
"EW
REP.
USED
Bath Tub
Garbage DilpooaIo
Caleh BolDs
Wuh Basin
Dilbwashars
Conductoro
Water Cloeet
Laundremats
f--
Grease Catch Bow
Sink
Water Softenero
Sump Pump" Ejecloro
Water Haatars
Sanitary Bubblers
Bar and Soda Wastes
Shower Bathe
Urinals
Floor Drains
Dental Cuspidors
~
Laundry Tubs
Service Sinks
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Fee Verified. Receipted and Recorded
Receij P~it and Inspection F...
.mm.mm:nmnmmSewer Fees
_mmj:n~nnPlbg. Faas
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Date %.dð. 7?:>
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CIty T,....,",
$ m .mmnnmnn.........n m...n nn...... _...nnn......n - ---
In the performance of this work the undersigned owner (or his authorized agent) of said premises and his authorized Plumber hereby agree to be bounden by end
submit to all statutes, city ordinances, and rules and regulations prescribed by the Boord 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 except as hereinafter listed,
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