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DATE •
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at No.St.and heTeby agrees to
comply with He rilles and regulations as now,or at any future time,established by the Board of Selectmen.
Am't.of Estimate S
Am't.Paid $
Owner
Address
_,)J-~tM-A
1~~~tA.~
Sketch of Senice Here •
•19
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CDnnection made in --J~L Q,...ol.Sh'eet.~\Vork completed _
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Duilder _