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&rviceNo.~77.z
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Kind of Pipe
Date
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Size 7c 2-.
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Size of Main
Lll"ation
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DATE --4-
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at Xo.St.and hereby agrees to
comply with the rules and regulations a,now,or at any iutHre time,established by the Board of Selectmen.
Address
Owner
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Builder ~•_Sl.+-=--~t~_
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_,_'_'_,_",.::etch of Service Here •
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Am't.Paid $_
Arn't.of Estimate $)1
Connection made in
Reroarks:
____________Street."Vork completed _19 •