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$ernee No•
-i3 7 -p"u I lie ve yo eo Fe/..Location
-Kitoct.of .Pipe SI,..,&;P Size of hiain
Repair-Rene_al--New Se...iee Location
Date Material Amount Total Date Amount
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~-6'-67 q-3-.57 J)e,pL>,s;r 200 0""
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Labor
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE ••.•••..••..•••••••••••••NO .
The unders;gned applies for the construction of a parti cuiar sewer connectiog No....... ....• . • . . .... ... . . . . .
Street and hereby agrees.to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't of estimate $ .
Arn't Paid $.
. . . . . . . . . . . . . . . . . . . .... . . . .•......Owner
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Sketch of Service Here ~.,
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I I i I I I"I 1)h1:r:J1 I I i I I i I I H I I =1 ...0"J-.
I I I I I n 1 71'hkb I LIJ I I I 1 I I I , I
Connection made in .
Remarks:
. . . . . . . . . . . . . ...Street.Work completed.. . . . . • . . . • . . . . . .19..