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TpWN OF LEXINGTON-BOARD OF PUBUC WORKS
'.;SliWER DIVISION
Am't.Paid $_
Connection made in Street.
Remarks:
DATE '5Z?S£'/''Z....-u '...L-_NO
The undersigned applies for the construction of a particular sewer connecting No.J//~A.
Street and hereby agrees to oomply with the Rules and Regulations governing the construction and use of Particular
Sewe'I'B,as now or at any future time established by the Board of Selectmen.
Am't.of-Estimate $~
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