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'Size
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Location
Size of Main
Wood Stree
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Amount Total Date
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t Date Material
DATE ---'_
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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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Connection made in Street.
Remarks:
Work completed 19
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