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SerYice No.1'76 '.1
Adcfresa 60 Outlook Drive
Size ft "Size of "'aill i IIKindofPipe ,
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Date rvtaterial Amount Total Date Amount I
2/7/5'Laoc>:z"'54 30 /A -.}/.,~//)~/he _/--/-''"-A IJ!)-(J I
10%~verbead 5 43 59 '73 /.J --1/-1;;-./~/!~L/f .../09!-
44-"_6""ewer ni e llil .34p 15 04 _9.P 9/1,-'l~:i.rlt
~;comnound 2 64 _J
A .....,.~"'"+-.nwn "hnv 1 ""5.0b 20 00 I I
til!',...,,-+-,TO U P,J.-i n.,.1 50
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TOWN OF LEXINGTON-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 a .....ct
Sewers,as now or at any future time estabIished by the Board of Selectmoo,
Arn't of estimate $,,..., . ,..
Lise of Particular
Am't Paid $,, , . , , , ,.., , . , .
___.....Owner
Sketch of Service Here
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Connection made in " . , . , , . ,.., , . , , , , ,....., , , ,.,Street.
Remarks:
.Work completed •••___. . . . . ...19..
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