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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.••..•••.•.••.•••••••••••NO .
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The unclers igned appIies for the construction of a partieuIar sewer connecting No... . . . : . . . . . . . . . . . . . . . . . . . . .
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now or at any fu ture ti me astablished by the Boa rd of Selectmen.
Am't of estimate $ .
Am't Paid $.
.Owner
SIuItch of Service Here
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Connection m.d.In :'Street.
Rem.rIca:
Work completed .............•..•19.•
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