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Date Material Amount Total Date Amount
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE.">.NO .
~"k The undersigned applies for the constru~tion of a parti~ular sewer <:on n~t ing No.. •____• . . . . . . . . . . •
.,'Street and hereby agrees to ~omply with the Rules and Regulations governing the constru~tion and Lise of Particular
Sewers,as now CK at any fulure time establ ished by the Board of Sele~tmen,
Arn't of estimate $.
Am't Paid $,.
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Sketch of Service Here
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Remarks:
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