12175 SW TIPPITT PLACE 12175 SW TIPPET" PLACE
I
s
w
u
v
A.
a
H
�n
.n
N
ADDRESS _� /�j5��!� � _ P, R m I T
P F R I'I I T CHARGE none
OWNER ��� �t�ule r" _ CONNFCTTJN FFE
PAID 3Y Q w ►r
TYPE OF bJILDING /- r. �� cam, DATI: CONNECTED !_
SERVICE RATE INSPECTION FEE
CONTRACTOR _. PA10 BY _ DATE
SIZE OF CONNECTION _ ASSESSMENT � PAID
3 y � - � s