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Size of Main
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Da~e Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE .NO......•••0
The undersigned applies for the construction of a particular sewer connecting No 0 0 0 '0 ••••••_ • 0 •••
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewe,s.as now or at any future ti me established by the Board of Selectmen.
Am't of estimate $ .
Am't Paid $.
•••~.~••••••~••••••4 ••~~~~.
Sketch of Sen'ice "'ere
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o-ner
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Connection made ;n Street.
Remarks:
Work completed ••••••0-._ 0 _ • • •••1 90 _
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