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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
NO.........•.DATE.,•..•..•...•.••.•..•.••.I,
I
The undersigned applie$for the COn$truction of a particular sewer connecting No i , .
Street and hereby agree$to comply with the Rule$and Regulations governing the con$tructior and U$e of Particular
Sewer$,as now or at any future time establi$hed by the Board of Selectmen.I
Am't of estimate $...,.,..,.I
Am't Paid $................I
...................f Owner
I
Sketch of Se,viee Here
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Connection made in ,Street.Work comPlete~19..
Remarks:I
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