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NO
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PUBLIC WORKSLEXINGTON-BOARD OF
SEWER DIVISION
TOWN OF
DATE ~21,.ty..3.r
The undersigned applies for the construction of a particular sewer connecting No.l:C ~.4addJ ~.
Street and hereby agrees to comply with the Rules and Regulations governing the construction and Ulle of ParticuJaI:
Sewers,as now or at any future time established by the Board of Selectmen.
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Arn't.of Estimate $Ii'.(J ()
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Am't.Paid $_'-Ga~/...v~wner-
,Sketcll of Service Here I \;.Ij .-
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,Connection made in Street.
Remarks:
Work completed 19
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