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.'Dat8 M.twtIal I AmDunt Total DIM Amount.
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ••.•.•.•'••••..••...•.••••NO .
The unclers igned applies for the construction of a particuIar sewer connecting No....... . . ... . . . . . . . . . . .
Street and hereby ag rees to compli with the Ru Ies and ReguIat ions governing the const ruction and use of Particular
Sewers,as now or at any future ti me estabIished by the Board of Se lectmen.
Arn't of estimate $ .
Arn't Paid $.
.Owner
Sketch of Service Here
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Connection made in Street.
Remarks:
Work completed _'9..