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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .............•...•......NO _
The und~lrsigned appIies for the construction of a partic ular sewer connecting No.• •
Street and hereby agrees to comply with the Rules and Regulations governing the construction and
Sewers.as now or at any future time established by the Boa rd of Selectmen.
-Am't of estimate $.
use of·Particular-
Am't Paid $.
._ _ • . "Owner
Work completed .••_ _ _ • " • • • • . ...19_ .
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