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Kind of Pipe Size 6 ~..Size of Main f ".J
...X ......New SeIYice Location
Date Material Amount..Total Date Amount ,
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'"T_-g 150 glM U/I)'#"~J.I:f A'"n d !
•25 •..:S9 63 39 8:S ~.m tI;~~{/L ./.I 4'0 f,f..
10«'Overhead;j-I /d"I/J4IQ~.
48 l';";6·Sew.r Pin-B @ .26 12 148 !............................2 IRA .~.Je1.n'b~_PDUnd
4-...._-Lt 1::f:1ef'i lld Shg 81 28 00
2 ...._-.'l'loucklrul:1 50 I
Patoeh1.DP.:10 X 3 ;10 00 ,
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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 Regulat ions gavern ing the construction a nd use of Particular
Sewers,as now or at any future time"established by the Board of Selectmen.
Am't of estimafe $ .
Am't Paid $.
..Owner
Sketch of SerYice Here
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1II1 UIIII 1111111111111111111",I I I I I 1-1-1-1 I I-I I II I II n I I '-'-'-'-1-'"
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Connection made in Street.
Remarks:
Work completed . . • • • • _••.-.. . ••.19••
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