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Date Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPI..@F PUBLIC WORKS
SEWER DIVISION
DATE•.....•.•••...•••••••••••NO.......•..•
The unclem igned a ppl ies for the construction of a part;cula r sewer connect;ng 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 established by the Board of Selectmen.
Arn't of estimate $.
Arn't Paid $.
..Owner
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-11-1
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Connection made i.n.. . . . . . . . . . • . . . . . . . . . . . . . . . . ...Street.
Remarks:
Work completed..._ . •,19..