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DATE ~
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
Thc underoignBd applies for a supply of water at 1>0.__St.and hereby agrees to
comply \\ith the rules and regulations as now,or at any future time,established by the Board of Selectmen.
Arn't.of Estim2te $,_
Am't,Paid S _
Owner
Address
~'<Ld~S~Icy ]3.<1 eLf"l,1\*-.dl .....
en 8-/:;.'
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•19Workcompleted_
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Sketch of Service Here
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Ccmnection made ln ~Street.
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