HomeMy WebLinkAboutFERN ST 49r Name Geral d S.Gray
I Address 4-9 Fern Street
I :!~v,/~-<3/-~~-Location
Service No.184
I Kind of Pipe Size Size of Main
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TOWN OF LEXI NGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISIO'N
DATE .......................•.-l'-JO.-.~~~
The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby agrees to comply with the Rules and Regulations governing the construction a nd use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't of estimate $.
Am't Paid $ , .
.," .Owner
Sketch of Service Here
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Connection made in.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Street.
Remarks:
Work completed 19..