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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS -.
SEWER DIVISION
DATE _ . _'.___.NO.'".
The undersigne:d a ppl ies for the construction of a particular sewer connecting No...•........•.•
Street and hereby ag rees to comply with the Rules and Regulations governing the construction and.use of'Particular
Sevvers.as nov.r or at any future time established by the Board of Selectmen.
Am"t of estimate $ _ _ _ .
A".,"t Paid $.._.._ _ _ .
."Owner
Sitekh of Se...ice Her
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Corinection made in _.... . . . . . . . . . . . . . . . . . . . . . . ...Street.
Remarks:
Work rompleted •.......••.". ...19 ..
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