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Date Material Amount Total Date Amount_._---
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORp
SEWER DIVISION
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DATE , .NO.......•..
The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby agrees to comply with the Rules and Regulations governing the constructio
Sewers,as now or at any future time established by the Board of Selectmen.
Am'tof estimate $....,.....
........
and use of Particular
Am't Paid $..,..,'"
."•••••,••••••••>••..,Owner
Sketch of Servic..Here
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II I I I HU-j I I-I ::I I i I I :-:I b I I I I 'I I I I-I l HI I HtH-fu_1 _11_;-i H-I-I/I I I-1-1 I-I I I I I I-IT I I I 1 I I-i I II I I
Connection made in ,, . , . ,Street,
Remarks:
Work completec/!• . . . . . . . . . • . . ...19 ..