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This article investigates the workings of sanitation technologies in late medieval English and Scandinavian cities through both written and archeological evidence. It defines the roles of city corporations and individuals in the areas of street maintenance and waste management between the years 1350 and 1550. It argues that although the urban environment was managed through seemingly simple technologies, such as latrines and guttered cobblestone streets, the technologies required a conjunction of city-provided services and individual behavior management to make them work as intended. The late medieval city governments under investigation therefore crafted social relations to create functional sanitation systems. Because responsibility for sanitation was allocated both to individuals and to the city government, the waste-handling and sanitation strategies of the late medieval city were possibly not as ineffective as they appear on the surface.