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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIYISION
_.
DATE NO._
The undersigned applies for the construction of a particular sewer connecting No.L?~~9.£..j/£
Street and hereby agrees to comply with the Rilles and Regu1ations governing the constructi:n:?iuSio;Particular
Sewers,as now or at lUIy future time established by the Board of Selectmen.
Am't.of EstilIlllte $,_
Am't.Paid $_
_~Owner
Sketeh of Service Here.-2 7 •
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I...i.to'-I-Ll),I'J IVI'
Connection made in Street.
Remarks:
Work completed 19 .;
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