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TOWN OF LEXINGTON -BOARD OF PUBLIC WORKS
WATER DIVISION 1
The undersigned applies for a suppl,'of water at No.se and hereby agrees to
comply with the rules and regulatioIls as now,or at any fntnre time,established by the Board of Selectmen.
Am't.of Estimate $_
Am't.Paid $
Owner
Address
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Remal"ks:
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19Workcompleted
1_'~71 ',Sketch of Service Here
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