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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ...................••••••NO....•.•..••
The undersigned appries for the construction of a particul ar sewer connectIng No.... . . . . . . ..• . . . . . . . . . • . • •.•
Street and hereby agrees to compIy with the Ru res and ReguratIons governing the construction and use of Particular
Sewers.as now or at any future time estabrished by the Boa rd of Selectmen.
Am't of estimate $ .
Arn't Paid $.
.Owner
Sketch of Se...ice Hefti
I I I I I I I I I 1 I I I I I I I I I I I I I j I I I I j I I I I I
UlLI II I I LI I 1 I I I i I I I I I I I I I U I I I I J'I
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I I I I I I I I I LI I I I I I I I I I I I I I I I I I I I I I I~
11111 III III 11111 11111 11111 III II I HnI I I r I I I H II II I II I I II I I I I I I I I I I InI I I Ij~L 111 T I I j I I I I 1 I I I I I I II I I I
I 1 I I J I I_IJ L I 1 I I I 1 I I I I I I I I I I I I I I I I !
I-I 1 I-I IT rIlJ I LI·I I 1 1 I I I I I L I I I I 1..1 I 1 I
Connection made in.. . . . . . . . . . . . . . . . . . . . . . . . .... . .Street.
Remarks:
Work completed.... . . .19..