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Pate Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .NO .
The underslgnedapplies for 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.....ice Here 42
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Connection made in :Street.
Remarks:
WarS<completed.. . . . . . ....".....19 ..