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Amount.Material
KW of Pipe
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Date
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TOWN OF LEXINCTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE ...•.••.•.••...••...•...-NO-I'!;>-...:..-4:<••-'"'-..-
,use of Particular
<'j...-~,-.-~
The undersigned applies for the construction of a particular sewer connecting No.........••_ _ _ __•••••••.•••
Street and hereby agrees to comply with the Rules and Regulations goveming the construction and
Sewers,as,now or at any future lime established by the Board of Selectmen.
Am't of estima~e $ ,..
Am't Paid $ ,.
..,".•••.•"...•Owner
Sketch of Semce Here2'9
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Connection made in .......•.....................,Street.
Remarks:
Work completed ••_ • _ •••'.• • • • ••.19.•
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