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W;,. ST.LUCIE.COUNTY UTILITIES:P.O:BOX.728 FT!PIERCE'FL 34982
- SEWER - — h. RES NAME cte Z�f
METER SZ. MIF -
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ACCT:# I
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�5)O J SECURITY DEP SERVICE ADDRESS
SERVICE FEE
- - ! SAME DAY FEE i.
SUBDIVISION LOT t i.' BLOCK SS
- _ - OVERTIME FEE
V METERINSTALL.' BILLING ADDRESS --_--
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CFC/WATER
FPUA CFC
PHONE# �
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-- - - - - CFC/SEWE-R - - -
' IThis application hereby request and authorizes the Utility to render-water-and/or-sewage-disposal
!Jn.0 GUAR.REV. -
ry services to the premises described above in accordance with tho Utilities present or futurerates,
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.
§ I 00 TOTAL CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE.
/ ! l SOCIAL SEC/
CUSTOMER i�
SIGNATURE :4-7--O� y Y\ . FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
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OFFICE USE ONLY /
I nA, TR RprviVRT1_ L' / CAS f. 0wi 0P'CHK# RECEIVED BY `� �-