HomeMy WebLinkAboutLAKE ST 7r----------------~e ~_a!U~
Address
Kind·of Pipe
Location
Size
Service No.La(k~.
#5''II~
Size of Main
Location
Date
Labor
Material Amount Total Date Amount
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at No.St.and hereby agrees to
comply with the rules and regulations as now,or at any future time,established by the Board of Selectmen.
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Am't.of Estimate $_
Am't.Paid $_
Builder _
Owner
Address
Sketch of Service Here
t'!-"7
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,
Connection made in Street.
Remarks:
Work completed _