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WATER COMM ST LUCIE COUNTY UTILITIES-P.O.BOX 728 FT.PIERCE FL 34982 .1
SEWER . RES
NAM C51
METER SZ. M/F (/� /
ACCT..# l 6 l0 D
IRR
SECURITY DEP'. SERVICE ADDRESS ;) Com`'U
SERVICE FEE
SAME DAY FEE. r^ C
SUBDIVISION LOT �-
O 4' BLOCK
OVERTIME FEE
BILLING ADDRESS'.
METER INSTALL.
_ - CFC/WATER.
FPUA CFC PHONE# J V I MOVE IIN/CLOSING DATE
- - - - — CFC/SEWER 7 - - --
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..
SOCIAL SEC/.
SIGNATURE \ FED ID J`�
f NAME OF SPOUSE SPOUSE SOCIAL SEC:.
OFFICE USE ONLY ,
DATE RECEIVED-.� / CASH CHK# RV 1� ��