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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.•.••••••.••.•••••.••••••NO .
The undersigned IPPIies for the construction of I pirtieul ar sewer connecti 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 Ii me establjshed by the Boa rd of Sal ICtmen.
Am't of estimate $ .
M't P.ld $.
.Owner
Sketch of SIIrvlca Hare 140
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Connection mid.In.~.•,I ••••••••••:• • • • • • • • ••• • •••St....t.Work eompl.ted...... ..F ••• •••••19 ••
Relll8rka:cO'V"'c-,{';;.'"<7/1/"'?';JS ....po yv~ri'-'J'~r</Ic-c:IF 0"-'r-",,=feu-£''',
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