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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
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The undersigned applies for the construction of a particular sewer connecting No .
Street and hereby agrees to comply with the Rules and Regulations governing the construction and use of Particular
Sewers,as now 0 rat any fu ture ti me established by the Board of SeIectrnen.
Arn't of estimate $.
Arn't Paid $,.
.Owner
Sketch of Service Here
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Connection made in "Street.
Remarks:
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Work completed 19..