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Kind of Pipe
Location
Size Size of Main
Date
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Material
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Amount Total Date Amount
Labor
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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
c9{!lpJ~...'Yjt~~he 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
Address
Sketch of Service Here
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Connection made in Street.
Remarks:
Work completed _19