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Location l'~v()n ::jt.
Service No.it u./
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Kind of Pi'e Size Size of Main
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2 \3/4"3 part unions
12 gds crushed stone
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DATE /.,,/\
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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
/
The undersigned applks for a supply of water at No,__."_.'!,/·'~~__.__St.and hm'ehy agrees to
comply with the l'tIies anil reg-ulaLions as now,OJ'at any future time;established by the Board of Selectmen,
".~C{~C!<,Am't,of hstJmate ''',1-''-'-"",--
Am't.Paid ~--1---,_._
Owner
Address
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Duildel'_
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Sketch of Service Here
Work completed.,__..,__'HI
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