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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER DIVISION
DATE ----'----'~NO.
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The undersigned applies for the construction of a particular sewer connecting No.~.
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particnlar
Sewers,as now or at any future time established by:the Board of Selectmen.
Am't.of Estimate $,_
Am't.Paid $______________Owner
Sketth of Service Here
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Connection made in Street.Work completed 19
Remarks:~.:...
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