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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
..DATE•.•••••..•...•.•••.••••••
.'-'."""t
NO ..
The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby agrees to comply with the Rules and Regulations go~erning the construction and use of Particular
Sewers,as now or at any future time estabIished by the Boa rd of Sel eclmen.
Am't of estimate $ , .
Am't Paid $..
..Owner
Sketch of Se'7~Here
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Connection made in.. . . . . . . . . . . . ... . . . . . . . . . .•....Street.Work completed.. . . . . . . . . . .~...•19..
Remarks: