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Date Material Amount Ii Total Date AmountI'
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I-P-9694 T i i ~,
TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.. . . ••... . . . • . .... .•.. . • .NO....•....•.
The undersigned applies for the construction of a pa rticula r sewer connecIing No... . . . . . . . . . . ... . . . . . . . . . . . .
SIreet and hereby agrees to comply with the Ru Ies and Regulations governing the oonstruction and use of ParticuIar
Sewers,as now or at any future time established by the Board of Selee tmen.
Am't of estimate $..•..••...
Am't Paid $.
.....................•............Owner
Sketch of Service Here
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Connection made in.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S,reet.
Remarks:
Work campieted.. . . . . . . . . . . . " . . 19..