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Date Material Amount Totar Date Amount
5/13/<;5 Ilabor
llo%overhead
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17128
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .•.•.••.•.•.••.••••••••••NO .
The undersigned applies for the coostruction of a particular sewer connecting No.....•...............••...••
Street and hereby agrees to comply with the Rules 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
Sketch of Service Hen
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Connection made in Street.
Remarts:
Work completed.. . ..•..........•19..