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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at N0 ;St.~d hereby agrees to
comply with the rules and regulations as now,or at any future time,established by the Board of Selectmen.
Am't of Estimate $..
Am't Paid $..
Builder ..'.
Owner br .
;1,Address ,i•.•i••••.............................................
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Sketch of Service Here
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Con~tion made in Street.
Remarks:
Work completed 19
WATER SERVICE RECORD
Name Service No.
Address ONE JOHN WILSON ROAD
Location
Repair-Renewal-New Service
i Date Material Amount Total Date Amount
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TOWN OF"LEXINGTON -BOARD OF"PUBLIC WORKS
WATER DIVISION
Sketch of Service Here
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