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Kind of Pipe Size Size of Main
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DATE-----------eTOWNOFLEXINGTON-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.
Remarks:
Work completed _19