HomeMy WebLinkAboutFOREST ST 3,
Service No.,J4 73or ~
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Kind of Pipe Sire Size of Main
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DATE _
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS 1..
WATER DIVISION
The undersigned applies for a supply of wateT at Ko.St.and h€1'eby agrees to
comply with the :rules and regulations as now,01'at any futme time,established by the Board of Selectmen.
Am't,of Estimate $,_
Am't.P"id S _
Owner
Add,'ess
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Builder _
Sketch of Service Hel'e
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Connection made in Street.
Rem.2rk.s:
Work completed_19
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