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Date Material Amount Total Date
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Labor
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DATE__,..--_-'-~--
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at No St.and he~eby 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 $.
Own.er ...................................................................................•......••
Address .
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V.17 '/.I-\./'"~lJ p ~-71-,
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Connection made in Street.
Remarks:
Work completed 19