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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.
Remarks:
Work completed _19
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