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PUBLIC WORKS
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LEXINGTON-BOARD OF
SEWER DIYIStON
TOWN OF
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!.r DATE NO._
,I The undersigned applies for the construction of a particular sewer connecting No.uMn~1.~r Street and hereby agrees to comply with the Rnles and Regulations governing the construction and use of Particular _
~-Sewers,as now or at any future time established by the Board of Selectmen.
t-Arn't.of Estimate $_
Am't.Paid $
_______________Owner
I ~_.•J Sketch of Service Herei j
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Connection made in Street.
Remarks:
Work completed --:-__19 •,,
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