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Na._M _\"""0.TaYal"D.-_ _SerrieD No.4.
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Address :::t.3 3 2 Mass.Avenue i
Le.x:3.ngton,Ma~./332 Mass.6 ...~ation 1332 Mass.Avenue :
Kind of Pipe Si",e Si"",of Main '
Ik!a~g&£*New Service Comm 8-6-5l Location I
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late Material Amoul"Lt Total Dale AmOlmt
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DATI
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
•
NO .
Tfle undersigned applies Tor the construction 01 a particular sewer connecting No,• • • _ • • • • • • • • • . . • • •
Street and flereby agrees to comply with the Rules and Regulations governing the construction and use of ParticuIa r
Sewers,as now or at any future time established by the Board of Selectmen.
Am't of estimate $........, ,
Am't Paid $.........., , . , ,
•. . . . . . . . . . . . . . . . . . . . . . . . . .~..__..."Owner
Sketch of SerYice Here
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Connection made in... . . . , , , . . . . . . . . . . . . . . .,.. ...Street.
Remarks:O ....i,itvi.1 Se..,..,;Ce f-/~-2.7
Work completed . , _ • . • • • _ _•• • •.•I 9 ••