11600 SW GREENBURG ROAD-1 �4
11600 SW GREENBURG ROAD
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Address// L'0,Y/V Permit No.
Name of Occupant J� �'Lr Permit charge ______ _ —
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Date connected
_ pe of Building_�, ,, i
�'LXd.��.�'' _..__ Inspection fee
Service Rate-----i- < < ___ - Paid by -__ _—Date
Contr actor Assessment J �' D O Paid___.
SizF of connection ��