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F77
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(� 3. WATER COMM_ ST.LUCIE COUNTY UTILITIES-P.O.BOX 728;FT.PIERCE,FL 34982
A SEWER RES
NAME:.:....;: , N 1 V V VI-Ck"
METER SZ'. M/F: .
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ACCT.#
IRR
$ � SECURITY DEP SERVICE ADDRESS
SERVICE FEE .
SAME DAY FEE
{
SUBDIVISION , LOT BLOCK
OVERTIME FEE
) ' BIILING ADDRESS ; + J I ��
METER INSTALL:
:. CFC/WATER
FPUA CFC PHONE#_ �`. I, `7 7 J�7� MOVE IN/CLOSING DATE
�. CFC/SEWER
GUAR.REV. This.application hereby request.and authorizes the Utility to render water and/or sewage.disposal
I' 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.
S .OC7 TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC/ p^�
i SIGNATURE
TED ID
f
NAME OF SPOUSE { � SPOUSE SOCIAL SEC.
A V
OFFICE.USE ONLY
DATE RECEIVEDCASH CHK# RECEIVED B