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Date Material Amount Total Date ~Amount
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Labor
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .NO ..
L ..
The unde rsigned applies for the construetion of apartTcuIar sewer connecting No.. . . . ..••••..••..••
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any Tuture time established by the Board OT Selectmen.
Am't of estimate $ , .
Am't Paid $.
.Owner
Sketch of Se...ice Here
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Connection made in . . . . . . . . . . . • . •. . . . . . . . . . . •• .•.Street.Work completed ... . . . ...... . ...19•.
Remarks: