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