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Labor
DATE---------"'--e
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 $_
Owner
Address
Builder _
19Workcompleted_
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Connection made in Street.-------------
Remarks: