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Address 4 Washington,Stre.et ,
Lexin'lZton.Mass.location 4 Washington street
Kind of Pipe SiR ~II Sin of Main ~I,
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Labor
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ...•.••.••.•.•••••,•••••NO..••••'".
The undersigned applies for the construction of a particular sewer connecting No............•..•.••••••...
Street and hereby agrees to comply wi th the Ru les and Regul ations governing the construction a nd use of Particula r
Sewers,as now or at any future ti me estab!ished by the Board of Selectmen.
Am't of estimate $.....,....
Am't Paid $.
...................................Owner
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Slr.etch of Service Here 4
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Connection made in.. . . . . . . . . . . . • . •. . . . . •. . . . . . . .Street.
Remarks:
Work completed ..•. . • . . . . • . . ...19..