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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 particu la r sewer connecting No......•..•........•.•.•.••
Street and hereby agrees to comply with tf1e Rules and Regulations governing the construction and use of Particular
Sewers.as now Or at any f ulure time established by the Board of Sel ectmen.
Am't of estimate $.•••.•••••
Am't Paid $,..
., . . . . . •. . . ...Owner
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Sketch of SeJVice Here 9
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Connection made in ...........•.•.•••••..., ••• •. •Street.
Remarks:
Work completed ,..• . . . . . . . • . ...19••
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