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DATE "
TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at No.St.and hereby agl'ees to
comply with the rules and regulations as now,or at any future time,established by the Board of Selectmen.
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Am't.of Estimate $,_~~~_
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Sketch of Service Here
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Connection made in t3.£.-r;C/'a1-d...&?'N'fJ;.,street.&t 'York completed ~_
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