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TOWN OF LEXINGTON-BOARD OF PUBLIC WO~;KS
SEWER DIYISION
DATE NO._
The undersigned applies for the construction of a particular·sewer connecting N/Jft ;,J:{er/l7t.?t7 ttl.
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $_------'_
Am't.Paid $_
_~Owner
f.'"i~rffll'7hketch of Service Here(FI a e
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Connection made in Street.Work completed 19
Remarks: