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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 connecting 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 ti me estabIished by the Boa rd of Selectmen.
Am't of estimate $ .
Am't Paid $..........•.••••
.Owner
Sketch Df Service Here
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Connection made in ,Street.
Remarks:
Work completed.. . . .•....•......19..