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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE., , , , , , . ,.., , , . , . , , , , . , .NO........•.
The undersigned applies for the construction of a particular sewer connecting No,..'".,.._ _ _ _ • • • • . . . . • • • • _
Street and hereby 'agrees to comply with the Rules and Regulations goveming the construction and use of Particular
Sewers,as now or at any fulure time established by the Board of Selectmen,
An't of estimate $,, , . , . , . , .
Am't Paid $,, , . , , , , . ,•., , .
......................~...~...._ . _....Owner
Sketch of Sel'¥ice Here PDIIiI '"'11
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Connection made in ,.,.,, , . , , , , . , , , . ,.., . , , , . , ,.,Street.
Remarks:
Work compl.eted ••••___ _ • _,_ • ••.19._
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