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DATE -.,.......-__
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,e.stablished by the Board of Selectmen.
Am't of Estimate $.
Arn't Paid $.
Builder ..
Owner .
Address ..
..
Sketch of Service Here
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Connection made in .Street.
Remarks:
Work completed 19