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The undersigned applies for the construction of a partienlar sewer connecting No.//,t,(~s:.Au-
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any future time established by the Board ofSele.ctmen.
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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER D'VISION
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Am't.of Estimate $_
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Am't.Paid $_
_~Owner
Sketch of Serv;"e lIere
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Connection made in Street.
Remarks:.
Work completed _19
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