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Date Material Amount Total Date Amount
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101.nt compound 2 176 -
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE..•..•..•••.•••••••••.•••NO.
The undersigned applies for the construction of a particular sewer conn~ting No,......................•••.•
St reet and herehy agrees to comply wi th the Rul es and Regulat;ons govern ing the construction a nd use of Particular
Sewers.as now or at any future time established by the Board of Selectmen.
Am't of estimate $ .
Am't Paid $.
._Owner
Sketch of Serviu Here
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Connection made in.. . . . . • . . . . . . . . . . . . . . . . . . . . . ...Street.
Remarks:
Work completed.._ . .J9 .•
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