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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE..••••.••...••••••.••..••NO .
-'It:
The undersigned applies fa r the construction of a particu lar sewer connecting No.... . . . . . . . . . . . . . . . . . . . . . . . .
Street and he reby agrees to comply with the Ru1es and Regu la tions gaveming the construction a nd use of Pa rtieuIa r
Sewers,as nOW or at any future time estabIished by the Board of Selectmen,
Am',of estimate $ ,..
Am't Paid $.,....,.,.,.""
..,...,............... . . _ . . . . . ....Owner
Sketch of S~ce Here 4-
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Coonection made in ..F!!P.'-:.!?¥:,(I!~..i?-~......Street.
Remarks:
(Jc«.97-1
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Work completed .~l!-.~~.....19.<t 7
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