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•TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
~.SEWER DIVISION
DATE ..J 1;/r.;tz NO.~Th~edapplies for the construction of a panicnlar sewer connecting No.G..-.~h.....l{~
Street and hereby agrees to comply with the Rules and Regulations governing the constructi~d use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $._
Am't.Paid $_"
Q'Co-...-=9="~","~owner
Sketch of Service Here
Connection made in Street.
Remarks:1'"
1.i.lud.,j,4
Work completed _19