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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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The undersigned appl ies for the construction of apartk ular sewer conneet ing No.0 0 • • 0 • • • • • •••••0 •••0 • 0 ••••
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers.as now or at any future time established by the Board of Selectmen.
Arn't of estimate $.0 ••••••0 •
AmOt Paid $0 ••0 •
•••••••••0 ••••0 •••0 0 ••••••••••••'"Owner
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Sket<:h of Service Here
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Connection made in ...•0 ••0 •••••••••0 •••••••••0 ••Streel.
Remarks:
Work completed •.••..••..••0 •••'9.•
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