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Date Material Amount Total Date Amount
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TOWN OF lEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.•..•...••...•.••.•••••••
".
NO
The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby agrees to comply with the Rules and Regulat;ons 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 $ .
Arn't Paid $..••......•..•••
......•.....................•.....Owner
Sketch of $erwice Here I •~
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Connection made in .....•......, . ... . . . . . . . . . • . ...Street,
Remarks:
Work completed.. . . . . . . . ,•......19..