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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ..NO .
The undersigned applies for the construction of a partieular sewer connec ting No....... . . . . . . . . . . . . . . . . . . . . .
Street and he,eby agrees to comply with the Rules and Regulations governing the construction a nd use of PartieuIar
Sewers,as now or at any tuture time establ ished by the Board of Selectmen.
Am't of estimate $ .
Arn't Paid $.
..'"Owner
Sketeh of Service Here
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Connection made in....•..•....••..•....•.•.......Street.
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