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Date Material Amount Total Date Amount
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ITOWNOFLEXINGTON-BOARD OF PUBLIC WORKS j
WATER DIVISION 1
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.
Arn't of Estimate $.
Arn't Paid $..
Builder ..
Owner .
Address .
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Connection made in -Street.
Remarks:
Work completed 19
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