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Date Ma,terial Amount Total Date Amouut
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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
A~<..SEWER DIVISIONDAT~.~A i I /13 ()'7~f NO._~__
The undersigned applies for the construction of a particular sewer connecting No.ff f ~~.
Street and hereby agrees to comply with the Rules and Regulations governing the construc:;r~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 Service Here 7 ...CJ e
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Connection made in ~Street.
Remarks:
Work completed __~_19