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HP-~'969'.It I I __---------
TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ..NO .
The undersigned applies fo r the construe!ion of a pa rticula r sewer connecting No... . . . . . . . . . . . . . . . . . . . . . . . . .
Street and hereby agrees to comply with the Rul es and Regulations governing the construction and use of Particula r
Sewers.as now or at any future time establ isned by the Board of Selectmen.
Am't of estimate $.
Am't Paid $.
.Owner
Sketch of Service Here
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Connection made in.. . . . . . . . . . . . . . . . . . . . . . . ....."S'reet.
Remarks:
Work completed.. . . . . . . . . . . . . . . . 19..