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,aWN OF L'EXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
eATE.......................•.NO .
The undersigned applies for the construction of a particular sewer ccnnecting No ".
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any future time estabHshed by the Boa rd of Selectmen.
Am't of estimate $........
Am't Paid $.
..,.,Owner
Sketc h of Senrice Here
1_I -U-i I I-I-i I I I I I !I I I I I I I I I I Ll_I
I I i r I r I-I T-II 1-1-1 11-1I-I-i-I I I I I I I-i
II L I I 11-1 1-i-I 1-1-1 11-1 IT-II -I I-I I I Ii
I I I I I I '-I r I-I 1-1-1 I I I-I I I -I I IT I -I I ,
I I I I ,I I I I I I I I-I I I I I I r I I I 1 III !-I-I 1-'-'[..,...I 1 I 1 I f II I I I I I I I I I I I I I I I I I I I I
I-I I I I I I I I I I I I I I I I I , I , I I I I I I I
Connection made in.. . . . . . . . . . . . . . . . . ." SIreel.
Remarks:
Work completed.. . . . . . . . . . . . ....19..