HomeMy WebLinkAboutCUMMINGS AVE DEMATTEIS•Name
Address
Kind of Pipe
Repair-Renewal-New Service
Location C/77/77/,r7/J
Size
Service No.<G 7'tJ
Size of Main
Location
Date
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•
~I.otcrial
Labor
Amount Total
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I
Date Amount
DATE ..
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at No.Ca-z/72"~f M.-.-St.and hereby agrees to
comply with the rules and regulations as now,01'at any fu lure time,est£l~hed by the Board of Selectmen.
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Work completed I 19
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CrnO?L'7 r /2",ena eAddress
Owner
Sketch of Service Here
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Remarks:
nujlder_~~~_~~~__
Connection made in
Am't,Paid $~~~~~~~_
Am't.of Estimate $~~~~_
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