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"TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.--.NO....•..•r ••
Worlt Completed.. . . . . . . . . . ...•..19.."3--fz.
The und~rsigned applies for the COrlstruction of a particular sewer connecting No ':-:.
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
ed
Connection made in.. . . . . • . . . ..••.: . . . . . . . . •... . . .Street.
RelNlrks:
Sewers,as now or at any tuture time establish
-Am't of ntimate $..........
Arn't Paid $.........".....
.
Sketch of S.....ice Here -2.4 7
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