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1,:~Claude Cole ',Seniee No.l.3S :j
#-t ";;.u L."..',-~7 Ledgelawn Ave.1
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Kind of Pipe COll.9-14-53 Sin Size of Main
JF!L7k New Service
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Location ,,.
Date Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE., , . , , , , , , , , , , , , , , , , , , , ,NO.•••,••••.
The unclersi gned appIies for the construe!ion of a particula r sewer connecling No,.".,....,..,...........,.
Street and hereby agrees to compiy with the Rules and Regulations gcwerning the construction and use of Particular
Sewers,as now or aI any fulure !ime estabIished by the Board of Selectmen,
Am't of estimate $,.., , . , . , .
Am't Paid $,, , . , , , , , .
, , , , • , . , , . , , , , , , , • , , . , . , . , . , , . , . ,.,Owner
Sketch of Se.vice Here
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Conneclion made in .•" , . , . ,••,.., . , , , , ,.., , , , ,.,Street.
Remarks:
Work completed • • • • • • • •....•.•••19..
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