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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER DIVISION
.DATE NO--'-_
The undersigned applies for the construction of a particular sewer connecting No.t9¥~hr &
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.
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Am't.of Estimate $._
Arn't.Paid $_
_Owner
."............Sketch Iof S rvice Here ,\?4 •~
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;Connection made in Street.Work completed .
I Remarks:
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