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ST LUCIE COUNTY UTILITIES P O BOX 728,FT PIERCE FL 34982
Lucie County - PCIS .
•03-2017_- 09:54:56
ACCT # .. ag,
9332/4289
LAN, LAURENCE B �EP. SERVICEADDRESS S LU��� �'I(.0Ir
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14 HICKORY DR
J PIERCE
34982 rEE
SUBDIVISION . :ry LOT-: BLOCK.
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unt Tendered: 521 .25 ALL BILLINGADDRESS cj I o j� rj �04<_�S
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unt Paid: 521 .25 &� 77'�
nge Due: ; 0.00 f PHONE MOV
El DATE
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This application hereby request and authorizes the Utility to render water and/ sewage disposal
services to the premises described a(ove ui-accordance with the Utilities.present or future'rafes,
rules and regulations,which:by reference are made a part of this contt aot Applicant agrees to pay
r ID: RODRIGUEZM the Utility;promptly;for such services m accordance wrtli`tlie es —hed rules and regulation"s
ff CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANS .
I
SOCIAL SEAlm
C/
/ SPOUSE SOCIAL SEC: <' .
is
Fi >E ONLY
DATE RECEIVED CASH CHK# RECEIVED BY
FERABLE
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