HomeMy WebLinkAboutLOCUST AVE 41A~·_.T..n ~'1].R1":AVilQnnA
Size of MainS;"e
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Kind of Pipe
IiIftV**YXZ N_Service COM.2-4_52 .Location
Date Material Amount Tolal Dale Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .......•............•...NO.'•.....•.
The undersigned appfies for the construction of a particular sewer connecting No.....,.,...•......,.....•••
Street and hereby agrees to compfy with the Rufes artd Regulations governing the construction and use of Particular
Sewers,as rtoW or at arty future lime estabtished by the Boa rd of Selectmert,
Arn'tof estimate $ ,
Am't Paid $..,.
. ,.....................•.....Owner
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Sketch of Service Here
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Connection made ln ...,...•,•...•,...........•...Street.
Remarks;
Work completed ..••_ . • • . . . . . ...19••