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Kind of Pipe
Date
~NewService
Material AmolOlt
Size
Total Date
Size of Main
Location
.Amount
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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER DIVISION
YC~".
DATE NO.
The undersigned applies for the oonstruction of a particular sewer connecting No._
Street and hereby agrees to comply ",ith the RuIes and Regulations governing the construction and use of ParticuIar
Sewexs,as now or at any future time established by the Board of Selectmen.
AIn't.of Estimate $,_
AIn't.Paid $_
_Owner
Sketch of Service Here •_.I
,
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1 i ,
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Connection made in Street.
Remarks:(j."i j iNa I S e .....v,"Co ellt1-'I~2~
Work completed _19
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