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TOWN OF
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LEXINGTON-BOARD OF PUBLIC
SEWER DlYISION
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WORKS "~c.
DATE NO _
The undersigned applies for the construction of a particular sewer connecting No.#9'&:&-elK
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now cir at any future time established by the Board of Selectmen.
Am't.of Esfuuate $,_
AIn't.Paid $_
_Owner
Sketch of Service'Here 4 =q •.\;I •,
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Connection made in Street.
Remar!>s:"Work completed 19
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