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;fOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER Dly.alON
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NO._
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DJcrE
The undersigned applies for the construction of a particular sewer connecting No._
Street arid h~hy 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 of Selectmen.
Am't.of Estimate $,_
Am't.Paid $_
_Owner
Sketch of Service Here
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Connection made in Street.
Remarks:
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Work ClJtIlpleted _19