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COMM ST.LUCIE COUNTY UTILITIES=P.O.BOX 728 iM PIERCE,'FL 34982
SER RES
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METER SZ, M/F
IRR ACCT.
SECURITY DEP SERVICE ADDRESS
SERVICE FEE
SAME DAY FEE dL
i SUBDIVISION LOT BLOCK
OVERTIME FEE v
METER INSTALL: BILLING ADDRESS pGc-
CFC/WATER r
FPUA CFC PHONE# 5(,E 1 �� .�� MOVE LQ,SING DATE
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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
r" 1 the Utility promptly for.such services in accordance with the established rules and regulations.
TOTAL CUSTOMERS DEPOSITS ARE NON 14EGOTIA13LE;OR TRANSFERABLE.
CUSTOMER -=�"-% / SOCIAL SEC/
SIGNATURE .��' FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY f
DATE RECEIVED = C'�CSA�.". . f (. RECEIVED BY .