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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
SEWER QtVISION
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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 Partic,ular
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $_
Am't Paid $_
_Owner
Sketch of Service Here •
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Connection made in 'Street.
Remarks:
Work completed _19
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