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DATE ~
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS \.
"WATER DIVISION ~,
The undersigned applies for a supply of water at No......St.and hereby agrees to
comply with the rules and regulations as now,or at any foture time,established by the Board of Selectmen.
Am't of Estimate $..
Am't Paid $..
Builder .
Owner ..
Address .
9 CHASe;
Sketeh of Serviee Here .
!
"-
II
~1.:1,10 "'l
.3 '1;J ""-I
~......II ..
Connection made in Street.
Remarks;
Work completed 19