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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 $_Owner
Am't.Paid $_Address
Builder _
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