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TOWN OF LEXINGTON -BOARD qF..PUBLIC WORKS
~~~..SEWER DIYIStO"
DATE V cZJ /9'.21·NO......
The undersigned applies for the construction of a particular sewer connecting No.-c>/::JI~k
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.ofEstimate $,_
Am't.Paid $_
_Owner
Sketch at Servire Here •,;t
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F Connection made in Street.
Remarks:
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Work completed _19 ..':~~~~,Ji!I