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Size Size of Main
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Date Material Amount Total Date AmoUilt
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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.'
Sketch of Service Here ..
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Owner .
Address ..Am't Paid $..
Am't of Estimate $..
Builder .
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Connection made in Street.
Remarks:
Work completed 19·