HomeMy WebLinkAboutCOTTAGE ST 40•Name
Address
Kind of Pipe
Repair-Renewal-Xew Sen-ice
Locatic
Size
Service No.6;:7..f
,d~7f'l ~'i'l/
1£tJ C;;7/a7'6'cl'1
Siz,"of Main
Location
I III
II
i
,
il
,.
"!!
,]IIIi
I
II,I
Date
•
~-Jatt'rjal
Labor
Amount !\Total
,
III
iI
\
II!!,.
I·
'i
11
Date Amount
DATE ..
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at Ko.St.and hereby agrees to
comply with the rules and regulations as now,or at any future time,established b~,.the Board of Selectmen,
•
~1)to-yyy.,LR 0 1e "'.
Jfo.e.~Q~-
Ovmer
Address
Sketch of Service Here
Ii!1\VII I !,./'T')I
-tliIIIJi-il '.11 1 ,111
..J]'.I!l','''''1.1 .1.Ii.I ,!I 1=1..*.·.·.Mfm.'•".1 .•'.., I ,J 1 _I .!'I ;I ".iii,.',.,,
I I I I j ,J 1 -'.ITTl!';I ''
"'1 !I IT±±=I If"~-i':'".I I !I .!
Am't.Paid :$
Builder _
Am't.of Estimate $~
."
,.19Workcompleted_
I
;I I I I
<!..,..J:;;C a.-j£Street..s t::
,I !I Ii;r I i
i ;,.I - - .
, , I I "I',"I I-t+++-1 Y !1 ~,-4+i
Connection made in
Remarks: