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Leeland Construction Coapany Se...ice No.13<11..~
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TOWN OF LEXINGTON-DEPT.OF PUBLIC WORKS
SEWER DIVISION
DATE .........•.•.•.......••••NO .
The unclers igned applies for the construction of a pa rticuIar sewer connecting No........ . . . . . . . . . . . . . . . . . . • .
Street and hereby agrees to comply with the Rules and Regulations goveming the construction and use of Particular
Sewers.as now or at any future time estabIished 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.Work completed.....•...........'9..
Remarks: