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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
I -SEWER DIVISION
I DATE , , •NO,.,••.•,•••
The undersigned applies for the construction of a particular sewer connecting No.,. ,...,•.•,.•., ,..., , , ,.•••
Street .nd.her.by agrees to comply with the Rules and Regulations geveming the construction and use of Particular
Sewers,.s now or at any future time established by the Board of Selectmen.
Arn't of estimate $..•.•.,..,
Amtt P.ld $~Io I Io ..
. , , , ,.., . , ,'.'..•...Owner
SkefCIh of Servin Ha,.
Con:nectton mid'In............ .~'.. .~..,. .St I"Ht~
Rlmarlel:
Work comp lated••, , •.'.• • • • • • , . ..,9..
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