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TOWN OF
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LEXINGTON -BOARD OF
SEWER DIVISION
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PUBLIC WORKS
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DATE NO,
The undersigned applies for the wnstruction of a particular sewer connecting No.L6>f¥r,/4.£.6 &££&.
Street and hereby agrees to comply with the Rilles and Regu1ations governing the wnstruction and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $_
Am't.Paid $_
_Owner
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Connection made in Street.
Remarks:
Work completed _19 •