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Service No.fa
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LexiutoD LocatiD''-I
Kind of Pipe 00](.2-lS -53 Size SUeaf Main
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Date Material Amount Total Date Amount
:t/20/5k 27 (f1 /-')-,~..,/l~AS~X:c//2 -i~,100;overhead 2 71 29 78 2 -2 A-,..-;?,,%/:'/(cr {lo/
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~hovel 00
l1 hr..~..>"'boa 1 50
6QI 73
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TOWN OF LEXINGTON-DEPT OF PUBLIC WORKS
SEWER DIVISION
DATE .
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NO .
The undersigned appl ies for Ihe construction of a particuiar sewer connecling 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 fu ture time estab!ished by the Boa rd of Se leetrnen.
Arn't of estimate $ .
Am't Paid $.
.....•.............................Owner
Sketch of Service Here
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CooneeIion made in.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .Street.Work completed :......:. . . . . ...19~:
Remarks:
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