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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVISION
DATE -3...0 .b //.NO.._
Th unde igned applies for the construction of a particular sewer connecting No.r~~.~
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Partictilai'
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $ _
Am't.Paid'$~
Sketch of Service Here
Connection made in Street.
Remarks:
Work completed _19