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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE/?!.~..~2............NO.....••••••
The unden;;gned applies for the construction of a particular sewer connecting No.........................•..
Street and hereby agrees to comply with the Ruies and Regulations 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
Skel<:h of Service Here ,I
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