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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
.SEWER DIYISION •
D~E NQ
The undersigned applies for the construction of a particular sewer connecting No.•£.8,.£<"H
Street imd hereby agrees to comply with the Rules and Regnlations governing the construction and use of Particular
Sewers,lIS now or at any future time established by the Board of Selectmen.
Am't.of Estimate $,_
Am't.Paid $_
_--==----_=----__Owner
Sketch of Serviee ~ere J"
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Work completed 19
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Connection made in Street.
Remarks:
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