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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER DIYISION
t'
DATE NO,_
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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 Ulll!of Particular
Sewers,as now or at any future time established by the IkJard or &lectmen.
Am't.of Estimate $_
Am't.Paid $_
________________Owner
Sketch of Service Here
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Connection made in Street.
Remarks:
Work completed 19'""'"~__JJ..~'.
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