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Amount
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TOWN OF LEXINCTON-DEPT.'·oi=PUBLIC WORKS
SEWER DIVISION
~...
DATE ;.NO ..
The undersigned appl ies for the construction of a particular sewer connecting No.......•.• ___ _•••••.•••..••
Street and hereby agrees to comply with the Rules and Regulations governing the construction and ~se of Particular
Sewers.as now or at any future time established by the Board of Selectmen.
Am't of estimate $ " .
Am't Paid $..............•
.............~............-
Sketch of Se....ice Here
_••••.....Owner
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Connection made in .......••.....................Street.
Remarks:
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Work completed ••_ _ _••_••••••••19••
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