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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVISION
01'.TE NO..,.-_
The undersigned applies for the construction of a particular sewer conneeting No./-6 ~?~\/&
Street and hereby agrees to comply with the Rules and Regulations governing the constructio::Cus%;Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $_
Am't.Paid $_
_Owner
Sketeh of Service Here I 45
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Conneetion made in Street.
Remarks:
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Work completed _19