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Kind of Pipe
Com.6-14-49 Location
,Date Material Amount Total Date t-A_tI,
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DATE,'"'"'-_
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DJVISION
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 $:.Owner ..
Am't Paid $..Address ..
Builder ....
...................19
Sk~~of ~rpce Here
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VI ','l~...
411.'~~"lIIIII ".
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..........................................~.Isn~t.e in Work completed .......................Connection mad
Remarks: