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PUBLIC WORKS
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LEXINGTON -BOARD OF
SEWER DIVISION
TOWN OF
DATE
The undersigned applies for the construction of a particular sewer connecting No......:""?..,L4'K.r<K d'X
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 time established by the Board of Selectmen.
~~:~"~_.:;;r~-----,
Am't.of Estimate $._
Am't.Paid $_
_Owner
Sketch of Servi~Here -.2-J6.
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Connection Irulde in Street.
Remarks:
Work completed 19
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