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location
Slse Size of Main ~Kind of Pipe \
locationRepair-Renewal-New Sewic:e Ins t.<tllsd bv devJtloner
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Date Material Amount Total Date 'Amount I
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:DAIE
TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
NO .
The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby agrees to comply with the Rules and Regulations governing tile COt1struction and use of Pa<ticular
Sewers.as nOw Or at any future time established by the Board of Selectmen.
Am't of estimate $,..,.
Am't Paid $,.
.,Owner
Sketch of Service Here
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Connection made in ,Street.
Remarks:
Work completed 19..