HomeMy WebLinkAboutFOLLEN RD LOT 4Name
Address FolIe"I?d.L~+1-(Vile...Lol-)
Location
Service No.
Kind of Pipe
Repair-Renewal-New Service
Size of Main
Location
Date Material Amount Total Date Amount I
Labor
HP-6411
.;
TOWN OF LEXI NGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ...............•...•.•••NO....•.•...
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 and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't of estimate $ .
Arn't Paid $.
.••.•••..........•....•............Owner
Sketch of Service Here
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Connection made in ...............•..............Street.
Remarks:
Work completed ............ . ...19..