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TOWN OF LEXINGTON -BOARD OF ,PUBLIC
SEWER DIYIS,ON
-~.-.:,~'--'i --;:c -
DATE
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(r--r
WORKS
NO
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The undersigned applil!8 for the construction of a particular sewer connecting No._
~'.Street and herebl-'agrees to comply with the Rules and Regulations governing Ule construction and use of Particular
Sewers,as now or at any future time established by the Roard IIfSelectmen..
Sketch of Service Here
Am't.of Estimate $-_
Am't.Paid $---="-,----,-----"1~xI~_Owner
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Connection made in Street.
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Work completed 19
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