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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .NO.,
The underslgned appl ies for the construction of aparticular sewer conneeting No........•. _••• • • . . • . . . . . . • .
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any fu lure time established by the 60ard of Selectmef1.
Am't of estimate $.
Am't Paid $.
. _ . _...."Owner
Sketch of Se....ice Here
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Conneetion made in... . . . . . . . . . . . . . . . . . . . . . . . . ..•Street.
Remarks:
Work completed ••• • •••• • •••••"19••