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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ...............•..••....NO......, ,••
The undersigned applies for the construction of a pa rticular sewer ccnnecting No.... • . ..•..•, .:, • , ,
Streef and hereby agrees to comply with the Rules and Regulations governing the construction ~'nd use of Particular
Sewers,as now or at any future time established by the Boa rd of Selectmen.
Am't of estimate $ .
Am't Paid $ , .
.Owner
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Connection made in ...... . . . . . . . . . . . . . . . . . . . . . . "Street.
Remarks:
Work completed ••• • . • , • .•.• ....19.•
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