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PUBLIC WORKSLEXINGTON-BOARD OF
SEWER DIYISION
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TOWN OF
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DAT~~
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,The undersigned applies for the construction of a particularseWeI connecting No.6"J?~5 c:::".;zT
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 $,_
Am't.Paid $_
_~Owner
Sketch of Service Here •
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Work completed 19
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Connection made in Street.
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ff Remarks:
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