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TOWN OF LEXINGTON:-BOARD OF PUBLI€WORKS
SEWER DlYISION
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DATE NO _
r
The undersigned applies for the construction of a particular sewer connecting No._
Street and hereby agrees to comply with the Rules and R,eglliations governing the construction and use of Particular
Sewern,as now or at any future time established by the Board of Seleetmen.
Am't.of Estimate $_
Sketch of Service H
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Am't.Paid $_
_Owner
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19Workcompleted_
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,Connection made in Street.
Remarks:
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