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N_Cra~CleB.Ders Se....lcli No.~
Addr_1707 Masll.Avenue
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,Kind of Pipe SIn Size of Maill
-•·'ew 5erYice Locetion
Date,Material Amount Total Date Amount
0
~_1 O_SF I,Qbor >11 cg:z..4 -.2./-,ff ('J,~'p",-".'p Y'<.3.5?'0-t7
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10 ''J6 O.H.9,19 101 ,12 (,-;2-.s;,.I/£~/.J (,,,76
,'7A t fin ,,>1 t.e n1 nP.,@.'70 ;;4 .~(l j ~;;.Ys .2-4'
lui-T;Bank Gravel @ 85 Q ...,..,
:-<..,..........~_.,C:h"v..1 'jji 1'\,,{1 19 ;;(1 REPAIR W.o.#1697
~......'"~""."....@ 1«........a ....,.,5/14/81 Labar(3 men 8 hr8.)
1 t ,yo ~..1.~.,...A.-I:;~Inn ::i,........2 6"X 2'TrllllB1te NilIPle
~,....CI T ......"nld n".tru 'H '"Ok 1 6"Trf,nSite Elbow 4~P
1 !tr.R~""'!'....~1 I....iIil '"'.n h ...nn 1 6"Femeo Adapter
Q~.,..'O~......\.0 ..n ....2hr Trucking
2BlOi,l:u MlUlkole Removed
Ihr Town Shovel
I nhor Patch 1<'x 1<'
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .NO .
The undersigned appl ies 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
Sewer'c,as nOW or at any future time established by the Board of Selectmen.
Arn't of estimate $.
Arn't Paid $.
..............................•...Owner
Sketch of Service Here
I -I -I1-I Ti-I -I 1-I
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I I I I I I I I I I I I I I F ~I I I I I I I I I I I I I I I ••1/I/i/i/I/lill/llllllil',1111111111
I I I I I I I 1 I I I I I I i I I I I I I I I :I I I I I I
I I I I I I I I I I I I I 11 [i [I [ \j I i I I I I I I I I
I I I I I I I I / I I / I iii I I I I I I I I I I I I I
I I I I I I I I I I I I I 1.1 :I I I I I I I I I I I I
I I I I I I I I I I j 1 I I I I I j I 'I '.I Ill/I
I I I , I I I I I 1 /I " I I I I : I i I Ii!I I I I I
I I I I I I I I I I I I I I I I I I I I I I i I I I I I
Connection made in .......................•..•....Street.
Remarks:
Work completed 19 .•