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Location j
Kid of Pipe Sbe Size of Main I,
New Service COM.10-5-53 Location ~,
Date Material Amount Total Date ~Amount I~~
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TOWN OF LEXI NGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
•...:;;..
DATE .NO...•......
The undersigned applies for the construction of a particular 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 establisned by the Boa rd of Selectmen,
Am't of estimate $ , ,
Am't Paid $ , ,
_...,...Owner
Sketch of Service Here
1 I I Iii L I I i I I I I II I I I I I I I I Il
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I I I I I I I I I I I 1 I I III I I I I I I I I 1 I I I I I I!11!!!I I 1ut!I I I I 1 I I 1 I 1 I i I I l-l I I 11 I
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I 1 I I I I I I I I I I I I I I I i L ;'I I I I
I '"I I I I I I 11-11111 I II-II I I i III I;I I I L
Connection made in .... . . . . . . . . . . . . . . . . . . . . . . . . . . Stree!.
Remarks:
Work campieted • • • • • __19••
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