HomeMy WebLinkAboutGROVE ST 101Name Service No.
Location 1 ,"-".•,-...L -~._'_
Kind of Pipe Size Size of Main
Location
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Date
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Total
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Amount
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Material
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trench dug by wner.
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Date
Labor !i
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DAT'EE~_
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of wateT at ~o.",""""..""," , , "..St.and hereby agrees to
comply with the rules and regulations as now,or at any futUl'e time,established by the Board of Selectmen.
Arn't of Estimate $"..'...,,,..,,,,.....
Am't Paid $,,,..
Builder ,..
O"vnel',, ,, ,, ,' ,,,.",.
Address,' '..
Sketch of Service Here
Connection mad
Remarks:
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