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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .•.•••.•....•.........•.NO........~......
The undersigned applies fo r the construction of a particular sewer connecting No...•.....• _____ _ • • • • • • • • •••
Street and hereby agrees to comply with the Rules and Regulations governing the construction and Lise of ~art;cular
Sewers.as now or at any future time established by the Board of Selectmen.
Arn't of estimate $ .
Am't Paid $.
~~..~..~..,~...• - _ . ___ •-.Owner
Sketch of Se....ice Here
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Connection made in Street.
Remarks:
Work completed .••__•••••__.'•••19••
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