11080 SW 121ST AVENUE 11080 SW 121ST AVEIVE
Q)
:3:
co
i
.�, *�44 1117
Address 11060 S-W, 121st Ave. _ Permit No.
Permit charge .._. .__..._.� ._.�. _.:_ .._._
Owner H. B. WJ I Liam,,; Conne ction fee doo
____,____ --------------- Paid by H. B. Williaws
Type of building Residence Date connected
113ervice rate J-00 per month Ins'?ection fee .�_..25
Contractor —__ It. H. William3� Paid by Date
Size of connection 4" _ Assessment Paid __