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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DlY.SION
DATE _NO.
•
t
•
The undersigned applies for the construction of a partieuiar sewer connecting No._
r Street and hereby agrees to comply with the Rul~and Regnlations governing the construction and use of PartieuIal-
Sewers,ail now or at any future time established by the Board of Selectmen.
Am't.of Estimate $_
Am't.Paid $_~_
_Owner
Sketch of Service Here .'
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Connection made in Street.
Remarks:
Work completed 19
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