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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
{)AU;NO.........•
The undersigned applies for the construction of a particular sewer connecting No.......•.•......••.••......
Street and hereby agrees to comply with the Rules and Regulations governing the construction and Use of Particular
$ewers,as now or at any future time estabIished by the Board of Selectmen.
Am't of estimate $ ,..
Am't Paid $.
. . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . ...Owner
Sketch Df Service Here
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Connection made in ....'.....•...................Street.Work completed ••••..••...•..•'.19.•
Remarks:
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