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TOWN OF
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LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVljilON
,,~,.~-'-'0'"C·-''''\1•
DATE N'o'.-'-_
The undersigned applies for the constiuetion of a particular sewer connecting No.L£'tf/7.&r)'eYe.ej
Street and hereby agrees to comply with the Rules and Regnlations governing the construetion and 'u.&of {'artIcular
Sewers,as now or at an~'future time established b~'the Board of Selectmen.
Am't.of Estimate $,_
Am't.Paid $_
_Owner
Sketch of Servi""Here I.s'+,'7 •f>~I',
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Work completed _Connection made in Street.
Remarks:
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