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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 Regulations goyerning the construction and use of Particular
Sewers.as now 0.-at any future time established by the Board of Selectmen.
Am't of estimate $ .
Am't Paid $.
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Sketch of Se...ice Here
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Owner
Connection made in ,Street.
Remarks:
Work completed ••• • • • • • • • • • • ••.19••