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TOWN OF LEXINGTON-DEPT,OFPttBLlC 'IJ\i ORKS
SEWER DIVISION
DATE,, . , ,......,..•..,•...•••''':..NO...•.•.•••.
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The undersigned applies for the construction of a particular sewer :-l!Onnecting No.., , ......................,..
Street and hereby agrees to comply with the Rules and Regulations governing the canstr etion and use of Particular
Sewers,as now Or at any future time established by the Board of Selectmen.
Am't of estimate $.,........
Am't Paid $.............•..
.................................Owner
Sketch of Service .He...
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Connection made in,,.,..,..,.....,.,,.,..,.,,,."Street.Work complet d...I ••,••••••j t'119 ..
Remarks:
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