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Serrice No.I
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3.9 P a u I 7i..ll.V"e."'R.acl Location
Kimt of .Pipe •."Sin ,SiQ of ~hin
Repair-Rene_al--New SerYice Location
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Date Material Amount Total Date Amount
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9..~'~-/"'"anls iii.'Z-2-57 7?~.p"'N.L ISIn.
I ~.,~_"'1.50 E/£.--.1.,i 2i'4 )2.
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE .•••••..••••...••••••,•••NO .
The undersigned applies for the construction of a particular sewer connecting No...........•••...........•..
Street and hereby agrees to comply with the Rul es and Regula tions governing the construction a nd 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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Connection made in .....•...•.•.•••...•...•..•....Street.•Work completed..._.••..........19..
•Remarks: