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;.A".....:L8 Oak St~."'t --5er¥ice No.120
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R................N_Serrice Location
Date Material Amount Total Date Amount
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,T""..?'1 +..CnlnftoUlld ."60 '"/I
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TOWN OF LEXINGTON-DEPT.Of PUBLIC WORKS
SEWER DIVISION
DATE •................•......NO
The undersigned a pplies for the construcHon of a particul ar sewer connecling No.........•• _ _ • • • • . . • . . . .'.'•
Street and hereby agrees to comply with the Rules and Regulations governing the construction 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 Se....ice Here
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Connection made in ........................•'.....Street.
Remarks:
Workcornpleted •••__•.~••....•.•19••
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