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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVISION
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Sketch of Service Here •
________________Owner
Arn't.of Estimate $,_
Arn't.Paid $_
DATE NO.
The undersigned applies for the construction of a particular sewer connecting No•.,sJ;f,$L/2?C£,I.
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at an),future time established by the Board of Selectmen.
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Connection made in Street.
Remarks:
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Work completed 19
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