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f nate Material Amount Total Date AaoQt
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Labor Comnr"",.........2 hr••ID.'75 :3 ISO
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DATE---:..------~~i"..L#lli"'-~
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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 .
Owner .
Address .
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Sketch ofjePjce Here
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Connection made in Street.
Remarks:
Work completed 19