HomeMy WebLinkAboutVINE ST 23Name
Address
Service No.;Z?j /
Date
Kind of Pipe
Rep~i:r:-Renewal-NewService
Material Amount
Size
Total Date
Size of Main
Location
Amount
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Labor
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DATE----------eTOWNOFLEXINGTON-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 $_
Owner
Address
l.-.....-__
Builder _
Sketch of Service Here-II""'"~.....
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Connection made in __-"lJ""--"'~::...-:·~....A:.._Street.St::..Wark completed _
Remarks:
19
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