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Labor
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TOWN OF
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LEXI!',l~TON-BOARD OF
SEWER DIVISION
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PUBLIC
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WORKS
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,DATE _NO'..,.
The undersigned applies for the oonstruction of a particular sewer connecting No.~_
Street and hereby agrees to COlllp]y with the Rules and Regi:llatioll8 governing the'construction and use of Particular
Sewers,asnoji-or at any future time establighed by the Board of Selectmen.
Am't.of Estimate $_
Am't.Paid $_
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_Owner
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•~-'Stroot.Connection made in ....::...---:_
Remarks:0.,..;"N a.(S ..YO,,}C te
Work completed.·19 ,-.-j