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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 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..,It-.J J...•I',a.1..Jl ill IR!:.IlJ D ,'\--1/1 V
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Connection made in :r~~.~~..~geet.
Remarks:
Work completed 19
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