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HP--9694 I _.___i I _.1:__,_i _l 1 ,--------~.------
TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DAT~.NO...,....•..
The unders igned applies fo r Ihe construction of aparticu lar sewer con n<!(;ti ng No..... . . . . . . . . . . . . . . . . . . . . • . .
Street and kereby agrees to comply with the Rules and Regulations governing the construction and USe of Particular
Sewers.as now or at any future time estabIished by the Board of SeJec tmen.
Am't of estimate $.
l Am't Paid $..,r Owner
Sketch of Service Here
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Connection made in Street.
Remarks:~;d'V ~~~
Work completed...... . . . . . . .....19..~~~...