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Size
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Size of Main
Location
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Date Material Amount Total Date Amount
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DATE ~__"""'-""'~':""'i__
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.
Am't of Estimate $.
Am't Paid $..
Builder .
O"WIler •.•.•.••••••....•....•..•..•.•.....••.•..•.•.•••••.••.••.•••••••••••••••••••••••••••••••••••
Address ..
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Sketch of Service Here
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Connection made in Street.
Remarks:
Work completed 19