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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVISION
DATE NO
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"-~t,..-
The undersigned applies for the construetion of a partieular sewer connecting NO•.£.~4dZ cf¥,.eej!
Street and herehy agrees to comply with the Rules and Regulations governing the construction and use of particciIar
Sewers,as now or at any future time estahlished hy the Board of Selectmen.
Am't.of Estimate $_~_~
Am't.Paid $~_~_~_
_Owner
Sketeh of Service Here •
•
ljj ~...1/V h r/r7.
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Connection made in Street.
Remarks:
Work completed _19
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