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,__A=ddress 21 'Shti4!iOLel:L-~S.J.l,t..rJila,SZft.J.l,t _
Location
oP...Service No.
lind of Pipe Size of Main
,1Bm~liW&New 'Serviee Location
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DATI;;,E ---........~·........~~"'_
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DI,VISION
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 ..
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Owner r;fk '-"I.'-"K•.2~.
Address !+~~.
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Connection made in Street.
Remarks:
Work completed 19