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TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
SEWER DIVISION
."~•.C'.--+.•
DATE !'IO.
The undersigned applies for the construction of a particular sewer connecting No.LI1 ~...~rJ1l
Street and hereby agrees to comply with the Rules and Regulations governing the constructio~~;Particular
Sewers,as now or at any future time establishM by the Board of Selectmen.
Arn't.of Estimate $,_
Arn't.Paid $_
_------Owner
Sketch of Service Here -&0 _.
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Work completed 19ConnectionmadeinStreet.
Remarks:
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