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Senice No.77/
Kind of Pipe
Repah'-Renewal-New Service
Size Size of Main
Location
Date
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DATE ~
TOWN OF LEXINGTON-BOARD OF PUBLIC WORKS
WATER DIVISION
The undersigned applies for a supply of water at N"o.~kra &e.St.and hereby agrees to
comply "ith the rules and regulations as now,or at an;r fu ture time,established by the Board of Selectmen.
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Am't.Paid $
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Owner
Address
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_____________Street.Work completed _In •