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WATER.. COMM' ST.LUCIE COUNTY UTILIT S-P.O.BOX 728'FT.PIERCE FL 34982
SEWER RES NA ( o..
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METER SZ. M/F II
. : IRR ACCT.# 1 .
$ U SECURITY DEP 'SERVICE ADDRESS 1 V C� `��S '� ,J U' .
SERVICE FEE ' V
SAME DAY FEE
SUBDIVISION L LOT 0 BLOCK 3 .
j OVERTIME FEE (�`'� ` ) '
METER INSTALL. BILLING ADDRESS
j CFC/WATER b
FPUA CFC PHONEbl)h
E IN/CLOSING DATPlar� E
CFC/SEWER
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GUAR.REV. This application hereby request and authorizes the Utility to render water and/c1r 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 ruls and regulations.
$ - TOTAL CUSTOMERS.DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.1
i -
CUSTOMERti ( ' SOCIAL SEF/
SIGNATURE J1 U UA FED ID
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NAME OF SPOUSE SPOUSE SOCIAL SEC.
I
OFFICE USE ONLY
DATE RECEI.VED ��" `I., C SFf'1` - CHK#_ RECEIVED BY—&A—* .