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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWIliR DIVISION
DATE .•...•.....•..•.•...•..•
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NO.
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The undersigned applies for the construction of a particular sewer connecting No.......,.• • • _ • •••••••••••••
Street and hereby agrees 10 comply with Ihe Rules and .Regulations goveming the construction and Lise of Particular
Sewers,as now or at any future time established by the Boa rd of Selectmen,
Arn't of estimate $.., .
Am't Paid $...,.., , . , , . , . ,
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Connection made in ".,'.,, , , , , . ,..,Street,
Remarks:
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Work completed " • •___ • • • • • • •••19..