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5er¥ice No.
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Ad'as.
Lenn
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Lecatien
K.....of Pipe'SiR ,,-Sin of Main I
•L .,5 .'New Senice .....Location I
Date Material Amount.Total Date Amount ,
......<7 I _R [abD~3 35 3 55 L .......,.,.,.'Vi lin .zoo.-:fh.n /.;:1&-I'h l
"a •'iii 23 F.4 'X"."4-,.x_.~..if,/'~r!"Y I."J';~;.,
.
ilot!:"Overhead 2 0.9 IJ ?1 ,1".2
~-'-~,.-12'--S"Sewer Pipe @ .26 ~2 .
.10
.--~o]:nt Caap ound ...2 ~2
.I h ..A L1ttlef'le l.l _.Shovel 28 po i
I:>h.....-'I'''''"kl Die 1 50
72 152 ,
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE •..........•.•..••.•..•.NO......•...
The undersigned applies for the construction of a particul ar sewer connecting No........•••. • . . . . • • • • • . • • . •
Street and hereby ag rees to comply with the Ru les and Regulat ions governing the construetion and use of Particular
Sewers,as now or at any future time estabIished by the Board of Selectmen.
Am't of estlrnate $ .
Am't Paid $,
...........,..•.......•.•.•..•••...Owner
Sketch of Sel'Yice Here
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I 1 1 I I I I 1 I I I I I 1 1 I I I 1 I 1 I I I I I 1 I I I I I
Connection made in,.., . , . . . . . . • . ., . . . . .Street.
Remarks:
Work completed • • • • . •••• . • • • •.•19••
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