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Date Material Amount Total Date Amount ,
5/15/2 lAbor '3'1 01 "lI_IL _...,f).0'"Il'!d /75"1<:>6
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ...~~NO .
The undersigned applies for the construction of apartic ular sewer connecting No.....•.....•....•.......••.
Street and hereby agret!s to comply with the Rules and Regulations governing the construction and use of Particular
Sewers.as now or at any fu ture time established by the Board of Selectmen.
Am't of estimate $.
Am't Paid $.
•.........'.'....................•."Owner
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U_I_I I..JI_I_I I_IDl
Sketch of Service Here
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ConnectiOf1 made in -.. . . . . . . . . . . •. . . . . . . ...Street.
Remarks:
Work completed . . • • . . • ..•.•••,.19..
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