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Kind of Pipe Size ~"Sin of Mai~J'
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Date Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE•..•••••.•.•••••••.••.•••NO .
The undersigned appl ies for the construction of a partieular sewer connecting No... . . . . . . . _ _
Street and hereby agrees to comply with the Rules and Regulations governing the construction and
Sewers.as now or at any future time established by the Board of Selectmen.
Am't of estimate $.
Am't Paid $.
Lise of Particular
- _ _ • _.•...o-ner
Sketch of Se....ice Here
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III I~II III III 1111111111111111 I'I I
1111 1/1111111111111111111111 I I I
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Connection made in... . . . . .... . . . . . . . .... . . . . . . . . .Street.
Remarks:
Work completed.. . __19..