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COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728 FT.PIERCE FL 34982
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SEWER RES
METER SZ. M/F
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SECURITY DEP SERVICE ADDRE4)_ � 1�- W boo
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{ SERVICE FEE
SAME DAY FEE
SUBDIVISION LOT �� BLOCK
OVERTIME FEE
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+DI METER INSTALL.' BILLING ADDRESS,�\
CFC/WATER
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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'p'resent 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.
I CUSTOMER Jf _7� SOCIAL ECAk
SIG_NATURE�C �... C( /// ~'--- FED ID J ` 2 "
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NAME OF SPOUSE. SPOUSE SOCIAL SEC. .
USE ONLY
IDATE RECEIVED 'D CASH CHK# RECEIVED BY