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2"7 o=utJ.ook Drive iI
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Address
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Date Material Amount.Total Date Amount i
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE ,.".,.',.•' , , , , . , , , , , ,•NO .
The undersigned applies for the construction of a particular sewer connecting No,,,'.,.,.•••_•••••......•••
Street and nereby agrees to comply with the Rules and Regulations governing the construction and Lise of Particular
Sewers.as now or at any future time established by the Board of Selectmen.
Arn't of estimate $..' . ,., . , .
Am't Paid $,, . ,., . , , • , , . , ,
.....~.....~.~~~..~.....-•_••••....O>.vner
Sketch of Service Here
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Connection made in .,.,.,.,..'.., , , . , , . ,...., , ,,.Street.
Remarks:
Work completed..••_•••..." t 9 .•
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