12540 SW 68TH PARKWAY 12540 SW 68TH-AYENUE-
s !�P .... 1z :. M ..�.
n0oRE5
• PF:Rf•111' CHARGE none
COMMON FEE
OWNER
P A 10 BY
__... !�., .�__ DATE. CONNECTED _ __ �._.--_-•-
TYPE OF BUILDING i a`''-� � 00
SERVICE RATE INSPECTION FEE
PAID g Y DATE
CONTRACTOR ___ ._.._....__.__---------
ASSESSMENT PAID
SIZE OF CONNECTION
f
i