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A1t.CLo...1c!3.qox Semee Nv.1~
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Sin of Main 8'.,Silre~,.
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Kind of Pipe.-
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_Date Material Amount Total Date Amount
LO/15/1:11 L-.b~r 60 115 80 115 /LJ-¥~W7 ..0~r/;{/A .....'A .....•
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:f0.1n:t _comtlolJDd .-3 100
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .•.........•.....•....•.
The undersigned applies for the construction of a partic ula r sewer connecting No._• •
Street and hereby agrees 10 compIy with the Ru les and Regulations g<werning the construction and
Sewers,as now or aI any fu lure time established by the Board of Selectmen.
Am't of estimate $., . , .
~Am't Paid $ ,,
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Sketch of Se,.,ice Here
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us.e of Particular
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Connection made in ,,.".,Street.Work completed •••••••••.••19..
Remarks:..;/"
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