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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVISION
DATE NO._
The under~igned applies for the construction of a particular sewer connecting No•..£U/;{£C;,,"'£
Street and hereby agrees to comply with the Rwes and Regulatiollll governing the construction and use of Particular
Sewers,as now or at any futUl"e time established by the Boaxd of Se\eetmen.
Am't.of Estimate $_
Am't,Paid $_---,_
_Owner
SketclI of Servil'e Here
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Connecti01l made in Street.
Remarks:
Work completed _19
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