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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 .
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Sketch of Service Here
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Connection made in Street.
Remarks:
Work completed 19