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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIYISION •
DATE NO
The undersigned applies for the construction of a particular sewer connecting No.z&k~r £./.
Street and hereby agrees to comply with the Rules and Regulation.s governing the con.struetion and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am'!.of Estimate ~,_
Am't.Paid $_
_Owner
Sketch of Service Here '1
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Work rompleted 19
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Connection made in Street.
Reinarks:
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