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TOWN OF LEXINGTON-BOARD OF
SEWER DIYISION
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PUB.LIe WORKS
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NO._
The undersigned applies for the construction ofa particular sewer connecting No._
Street and hereby agrees to wmply with the Rules and Regulations governing the construction and use of Partienlar
Sewers,as now or at any future time established by the Board of Selectmen.
Am't.of Estimate $_
AIn't.Paid $_
_Owner
Sketch of Service Here •
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19Workcompleted_
~,I Connection made in Street.
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