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Loeation 922 8 ••••AYenue
Size Size of Main
Location
Date
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Material Amount Total Date
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DATE~·~_··;...·_,;.....'"
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
!~"WATER,·DIVISION
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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 ..
Address ..
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Sketch of Service Here
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Connection made in .Street.
Remarks:
Work completed 19