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D~E NO _
The undersigned applies for the construction of a particular sewer oonneeting No.qI,2/&.££$-e
Street and hereby agrees to comply'with the Rules and Regulations governing the oonstruclion and use of Particular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $,_
Am't.Paid $_
_Owner
Sketch of Servil:e Here.,>~_.-
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'.f,:$.--i~.-A·~-.-;-,{a'·;-!,-......""'jJ-t'/-ffi--_o~..i-.:...--,,;.,'>:J:-,__:"'+.,;,.-"-~__.:..~:1';':;e:.::,'-.-l ..:;~·~-i--i-'/iil on)+N*--~'-+i -.,.,:."ti'",..-.,-",",w ---;-,,;~:,~;tt-~<¥;
~Connection made in Street.
Remarks:
Work completed _