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Size of Main
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Date 'Material A.mount Total Date Amount
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TOWN OF LEXINGTON -BOARD OF PUS$C WORKS
WitTIl DIVISION
The undersigned applies for a supply of water at No St.and hereby agrees to
comply with the rules and regull:lt~ons as now,or at any future time,established by the Board of Selectmen.
Am't of Estimate $..
Am't Paid $.
Builder .
Owner ,·.,itc.·.~.
Address .
..
Sketch of Service Here
Connection made In ..Street.Work completed 19