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Date Material Amount Total Date Amount
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Labor
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I jIP-969....- j j ..._..--_._-
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE •.••••..••••.••••.•••••••NO .
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The undersigned appl ies for the construction of aparticula r sewer conneeti ng 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 $-.
Am't Paid $.
..Owner
I
Sketch of Se....ice Here Z
IIJUI I I I I I I I I I I I I
IM_~/.a_J'+'I I I I I I I I I 11-[-1 fIJI I [ I I hfIJ.Il...t.....+
I I LrT_l'f'I L I_I I I I I I I Id~,bl"71 I I_I PI loht-b I
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Connection made in.. .....__. . . . . . . . . . . . . . . . . . . . . .Streel.
Remarks:
Work completed.....••...•.•....19.•