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Date Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .•.•.•.•••.•••.•••••••••NO,'"••••..
The undersigned aPI'iies for the construction of aparticu Iar sewer connectlng 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 futu re time established by the Boa rd of Seleetmen,
Am',of estimate $..,.., ,...
Am't Paid $., ,.., , . , ,...., .
•....•.....•.•.., •. ...• . . . . . . . .....Owner
Sketch of Service Here
I I III I 1 1 1 1 I I I 1 I I_I I 1 I I I 1 1 1 1 I
1 1-1-1-1 I 1-'_I 1 I I I I 1 1 r I 1 1 1 1 1 1 1 1 I
1 1 1 I I I I I 1 I I 1 I I L_I-I-II 1 I 1 1_1-1-1-1
I I I 1 1 I I I I 1 I I I I I 1-1 I 1 I I 1 1 I I I I
I I 1 1 )I I I I I I I 1 I 1 I 1 1 I CCll-l-r-1
Conneetion made in . , ,..,.., ,••.••,.., ,.••, . . . . . . .Street.
Remarks:
Work completed ,..• . . ......, ...19••