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COMM.- ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL 34982
__- ,:SEWER.. RES
NAME: ��. •/ �%�ii?r
METER SZ. M/F
IRR ACCT.#
SECURITY DEP SERVICE ADDRESS / /(JLJ G
SERVICE FEE
SAME DAY FEE . SUBDMSION J� ' LOT I. BLOCK J�,o
OVERTIME FEE
2 BILLING ADDRES
L S
J� METER INSTALL.'
CFC/WATER
FPUA CFC ,G i'!%:� ,
PHONE#ACS %'. l G v� MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
-- LATERAL rules and regulations,which by reference are made a part of this.contract.Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.,
$ ! TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER / " �y SOCIAL SE(;/
SIGNATURE- mac�'= '/� =�- FED ID - =
NAME OF SPOUSE SPOUSE-SOCIAL SEC.—..
OFFICE USE ONLY G�
DATE RECEIVED CHK# . s/ RECEIVED BY