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TOWN OF=GTON-BOARD OF PUBLlcD:~-R-K"'-S---------_·~
WATER DIVISION
The undersigned applies for a supply of water at No.St.ahd hereby agrees to
comply with the rules and regulations as now,or at.any future time,established by the Board of Selectmen.
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Am't.Paid $~__
Owner
Address
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