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Address 7;:"her';.Jl :iD C01.1y·t
Service No.
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Kind of Pipe Size Size of Main
R~NewSenice Location
Date
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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a snpply of water at ::-<0,St.and hereby agrees to
comply with the rules and l'egu!ation'l a,no'\\',or at any futme time,establishe.d by the Board of Selectmen.
Anl't.of Es.tim~te $.__~OwneT
Connection made in Street.
Remarks.:
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•19Workcompleted__~,_
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Address
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