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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.
Arn't.of Estimate $ _
Am't.Paid $_
Builder _
Owner
Address
Sketch of Service Here
Connection rna
Remarks:
I I I I I I I I I I I I I I I I I !~I I I I I I I I I I I I I I I I,-~r'...,.,~
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'rfL.~de in ..-Street.Gl,..Work completed 19