Form12.3m.11-06.Wade
ERHIT
APPLICATION FOR PERMIT TO DO PLUMBING
ILA
Haverhill, MMass.,
190
To the Board of Health:
The undersigned hereby applies for a permit to do plumbing work,
according to the following specifications:
Location of bulldIng, No.
Ward
Nearest cross street?
Nature
building?
How many storles?
New building or reconstruction in old building ?
Owner and address?
Architect and address?
Builder and address?
Plumber and address?
PRIVY-Where located?
Is vault water-tight?
Of what material
vault built?
How ventilated?
CESSPOOLS-How many?
Where located?
How near is it to the house wall ?
Are they water tight?
Material?
Are they
Material?
MAIN DRAIN-Inside bullding and four feet outside cellar wall?
Is it extra heavy?
Diameter?
Is it connected with public sewer, or
a cesspool?
Is it above or below cellar bottom?
f what pattern?
How many clean-outs are there and
Are they placed in man-holes?
Size and material of man-holes?
Material of pipe thence to cesspool or sewer?
Diameter?
TRAP IN AIN DRAIN-Material?
Diameter?
Has it hand-holes and proper covers?
Is it inside or outside of house?
FRESH AIR INLET-Material?
Diameter?
Where does it open?
SOIL PIPE Material ?
Diameter?
Does it extend through roof ?
Are all branches over twelve feet in length ventilated?
WASTE PIPE Materlal?
Diameter?
Does it extend through roof ?
Are all branches over fifteen feet
length ventilated?
RAIN WATER CONDUCTORS Where do they run to?
Are they Inside or outslide of house?
Are they trapped?
SAFE WASTES Where do they run to?
REFRIGERATOR WASTES Where do they run to ?
TANK OVERFLOWS (Boiler supply). Where do they run to?
UNDERDRAINAGE-What means are employed to remove surface or ground-water?
WATER CLOSET APARTIENTS What means are employed to ventilate W. C. apartments?
Location, ownership and detail must be complete and legible
