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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE •...•.•.•.•••.••.••••••••'NO .
The unclersi gned applies for the construction of a particular sewer connecting No.... . . . . . . . . . . . . . . . . . . . .•.•.
Street and hereby agrees 10 comply with the Rules aoo Regulations governing the construction and use of Particular
Sewers,as now a r at any futu re ti me estabIished by the Boa rd of Selectmen.
Am't of estimate $ .
Am't Paid $...............•
.Owner
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Connection made in ................•........."....Street.
Remarks:
Work completed...•...........••19..