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DATE__~-",-~:--~
TOWN OFT,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.
Am't of Estimate $.
Am't Paid $.
Builder ..
Owner ,'; .
Addres,s ...............................................................•........•..•...••.•...••.•
.,.
Sketch of Service Here
Connection made in Street.
Remarks:
l
Work completed 19
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