HomeMy WebLinkAboutMASS AVE 1977Name
Address
.-
Date
Kind pf Pi"
.Renewal-New ServiceRelJ8Jr-
Material Amount
I,
I·
Location
Date Amount
Labor l .,."."
L ~,..._>Wr _
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TOWN OF LEX~ARD=O~PUBLI::;O-R-K-S----",~S1
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.
Am't.of Estimate $ _
Am't.Paid $_
Owner
Address
Builder ___
Sketch of Service Here
19
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e in ~OV)../)......Street.~Work completedConnectionmad
Remarks: