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I C;<..........1.11'B)czoof't Senrice No.Q
r ~ew Senrice ro __.,_,,_<."n Loca··- -
I Date Material Amount Total Date Amount
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,V6~,.,tc:':n L ':10 M f()l '1,'.•70 f\lt'I.I..-Z J_/3J 00 _
I u.,'"I C:n Lm ....~~16 10 r;-r;-I Q7 1JI A ..'~Ll?}J/#.11 .<""J'¢
:'00(Overhead 5 60 t:7 l ,~~.6L I'A
...'k6'_6"Sewer Piue @.28 12 88 '
i , _f,it Elbo1f 1 15,
.T~4 ~4o oWld 2 76 .
:T.4 40 40'....~..,n Shm,.,11 <::hra @1 00 1'>00..
i 'l"_'nlr4 .....?h....i1.7<::1 <;0
PAt:",h ina 1 0 x "l 10 00
[12k B6
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DATE
TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS'
SEWER DIVISION'
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NO.....•••:•.~
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The u nde rsi gnad a pplies for the construction of apartic ular sewer connecting No.....•..•..•..•....•,.•,••.
St"reet"and hereby agrees 10 comply wilh the Rules and Regulations gO'olern,ng the construction and use of Partkular
Se"",ers,as no"",or a any future time eslablished by the ~Board of Selectmen.
Arn't of estimat"e $.
Arn't Paid $._ _.
.Owner
Sketch of Service Here
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Cannection made in.. . . . • . . . . . . . . . . . . . . . . . . • . . ...SIreef.
Remarks:
Work completed •...........••"19..
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