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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .............•...........NO...•...•.•.
The undersigned appl ies for the construction of a parIicular sewer connecIing No... . . . . . . . . . . . . . . . . . . . . . . . . •
Street and hereby agrees to campiy with the Ru Ies and Regulations gaverning the construetion a nd use of Particula r
Sewers.as now or at any future time estabIished by Ihe Boa rd of Sel ectmen.
Am't of estimate $ .
Am't Paid $.
.Owner
Sketch of Service Here
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Connection made in.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 treet.
Remarks:
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Work completed 19..