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D.te Material Amount.Total Date Amount ,
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919 ----C.__..J
TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .....................•..NO .
The undersigned appl Ies for the construction'of a partic ula r 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 future time establ;shed by the Board of Selectmen,
Am't of estimate $ .
Am't Paid $.
••••.•.•."Chovner-
Sketch of Service Here '4
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Connection made In :Sfreet.
Remarks:
Work completed •.••__••••,•.•_.19••