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Date Material Amount Total Date Amount
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I,n'JI:Overhead 2 98 ¢{JfLL."/i U (/j'Ii,/L.11-9-i
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21,I _6"Sewer PiDe @.26 6 21J /-sf.!4/I
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TOWN'OF tEXtNGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE ••.•...•.••..•.•.••.•••.NO .
The undersigned applies for the construction of a particular sewer ccnnecting 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 $.
Am't Paid $..........••••.
.................•..........•...."Owner
Sketch of S....ice H.re
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A:onnectilm made in ...... ••. . . . . . . . ... . • . . . . . . ...Street.
~rnarks:
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Work completed . • • • . . • • . • . ••••.,9 ..
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