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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.•.••••.••..•.•••••.•.•••
oF •_<;,
NO .
The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby ag rees to compl y with lhe Rules and ReguIations governing the oonsIruction a nd use of Particular
Sewers,as now or at any future ti me established by the Board of Selectmen,
•Am't of estimate $ .
Am't Paid $..............•.
.Owner
'.Sketch of Senoke Hen I
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Connection made in.. . .:.. . . . . . . .... •..Street.
Remarks:
Work completed...........••....19..
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