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Name
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Service No.1:S4
Address 38 'ftman Road
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","IIIA New Se...ice COX.11-8-54 Location
Date Material Amount Total Date Amount
9/27/5 L bor .7 37 9-.c --'/./l~_r ?fd 2::<ff-1'J
1 b'!overhead -4 '7S 52 Ie It ,
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:'I bl -e.seW'er pipe •.32 9 60
--..,l..'M+d 1 80,
I 9-h~...+""""Abovel 5.00 10 00 .
2 h~..To'0"--'1"""A 75 .1 50 ,
,'75 01)
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE .........•.•••...••.••••NO...•••••••I~I
The undersigned applies for the construction of a partieular sewer connectlng No......•.........•.••••..•.
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or a t any futu re time established by the Board of Selectmen.
Am't of estimate $...••..•..
Am't Paid $, , .
.,..,Owner
Sketch of Service Here
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,• J III I 111'11111 I U'111 U 1111_III
1 L I 1 I I L I I I I U I I I I J I I I I L I I _l I I I I I-Ir I I I I I_I I I I I II I I I I I I I I L I I I IU-I-r
I I I LJ I U I_I I U IiI I I'Ll I I_I U I U I I-Ir-II I I_I1_1_1 IJ~J II I-I 1_1_1 I_I I I I I_U I I
I I I-I J LLI I ~IITIUI I-II TTl-II_I I II-II-I-11-1-11-1-1 I I I I r I I 1·1 I I I I I 1 I -I-IIT I [-'-I
Connecti on made in..................•, . •. . . . . ...Street.
Remarks:
Work completed 19•.