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Repair-RenewaJ--New Senice Location
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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 agrees to
comply with the rules and regulations as now,or at any future time,established by the Board of Selectmen.
Am't.of Estimate $,~
Am't.Paid $~~~~_.
Builder _
Owner
Address
Sket.,h of S en1ce Here
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Connection made in Street.
Remarks:
Work completed _19 •