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Lexington 23 I W;'"T h 'r'O e J?o acl"LocatioII ,'-•
Kind of Pipe Size 6"Size of Main 8""
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....9094 .._._.__L--._~---~~-----------'.._....-.-_.--.-------.------------,
TOWN OF LEXI NGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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DATE.......•...••_••..••.••••NO.;...•...••
The undersigned a ppl;es ior the construction of a particular sewer connecting No..... . . . . . . . .•..........••.•
Street and hereby agrees to comply with the Rules and Regulations governing the construction 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 Se...iee Here
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Connection made in Street.
Remarks:
Work completed 19..
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