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Kind of Pipe
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Sise
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Size of Main
Location -l-
::>at"e Material Amount.Total Date Amount
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Labor
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TOWN OF LEXINGTON~DEP-T.·OF PUBLIC WORKS
SEWER DIVISION
DATE NO........••
The unclers;gned appIies for the construction of aparticular sewer connecting 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 $.
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.......................~~.
Sketch of Service Here
I I II I I I I I I I J I I I I I ( I I I I I I I I J I I I I I f I
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. . . . . . ...Ch.vner
Connection made in ,.., . . . . , . , . . . . . . ...Street.
Remarks:
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Work completed • . . • • ••••••" •••T9 ••