HomeMy WebLinkAboutOAKMOUNT CR 6r'e Name
Address
Kind of Pipe
R~pair-Renewal:::--:N(;lw Service
Location
Size
Seryice No.2//3
Size of Main
Location
Date
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Labor
l,Amount Total Date Amount
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DATE~---------e
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 $_
Owner
Address
Builder _
Sketch of Service Here
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Remarks: