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N_e Service No.
Location
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Repal~enewal_NewSe....ice-
Date Material Amount Total Date ~t
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS',t........,..~....
SEWER DIVISION
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•DATE ...•'.•••.••.••••.•••••••
,..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 the construction and use of Particular
Sewers.as now or at any future time established by the 130ard of Selectmen.
Am't of estimate $ .
,'Arn't Paid $.......•........
~_~OYiner
Sketch of Service Here I ';if.()
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Connection made in ........•...••.••...•..•......Street.
Remarks:
Work completed 19•.