HomeMy WebLinkAboutTOWER RD 25l'll:ll1le
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Locatioll
Size Size of Main
Date Material Amount Total Date Amount
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 $_
Builder _
Owner
Address
,Sketch of Service Here -I I '_.~:t
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Connection made in Street.
Remarks:
Work completed _19