HomeMy WebLinkAboutFOREST ST 6•
Date
,-.'
Name
Address
Kind of Pipe
Repair-Renewal-New Service
Material Amount
Location
Size
Total
Service No.
&h,re6/eF:!,ee/
Size of Main
Location
Date
:<'/7
Amount
,
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•~0;;,
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Labor
II,
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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER DIVISION
DATE NO.==-=-=_~
The undersigned applies for the construction of a particular sewer connecting No.6 EOrSJ'f cF/
Street and herebyagrees 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 $_
•
_Owner
Am't.Paid $_
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t.rg.~.2 t""\...-'f..J J r--'--,-,/
Sketch of Service Here
Connection made in Street.
Remarks:
Work completed ~_19
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