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>ate Material Amount ,/"Total Date Amount-,
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .................•....•.NO...........-....
II ""(he undersigned applies for the constNction of a particular sewer connecting No....•...•• • • • • • • • • • • • • • • • • •
Street and hereby agrees to comply with the Rules and Regulations governing the construction and ....se of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Arn't of estimate $.
Am't Paid $.
.Ovvner
Sketch of Se...iee-Here
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Connection made in ...... . . . . . • . . . . . . . • . . . • .... ..,Street.
Remarks:
Work completed •••_- •__••••••_.19..
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