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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER DIVISION
DATE NO.
The undersigned applies for the construction of a particular sewer connecting No./t6.U~/W4 &U.#vt::
Street and hel'eby agrees to comply with the Rilles and Regulations governing the construction and use of Particnlar
Sewers,as now or at any future time established by the Board of Selectmen.
Arn't.of Estimate $_
Arn't.Paid $_
_Owner
Sketch of Service Here I~I.~.,.17/&
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