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SerYice No.
......_.44 PElll]Rev_re Boad .
Location~.,.Paul 7(e"ere."811'J..
Kind of Pipe
Repair-Renewal--New Service
Size ~"Size of Main
Location
Date Material Amount Total Date Amount,
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Labor
HP-969....J~b-_._..._--~.--~-----------
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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 go"erning the construction and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Arn't of estimate $.
Arn't Paid $ ,..,..
•.•.....•......•.•..••_•••.•••••..Owner
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Sketch of Service Here
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Connection made in.. . . . . . . . . . . . . . . . . . . . . . . . . . . ...Street.Wark completed.. . . . . . . . . . . . . ...19 ..
Remarks: