HomeMy WebLinkAboutMisc Letters COMM ST`LUCIE COUNTY UTILITIES»P.O.BOX 728,FT.PI16CE1 FL'34482 j
RES NAME (A) ( !-! 1,6-1,4.--11=--T
.tER SZ. M/F (oho {
ACCT.#
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SECURITY DEP SERVICE ADDRESS CU ( ( Al '
CC
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SERVICE FEE f.C V-c C Sc ?
SAME DAY FEE i
SUBDIVISION LOT BLOCK
' OVERTIME FEE f
�..�` BILLING ADDRESSC_
TyfETER INSTALL.'
CFC/WATER
b FPUA CFC
W, PHONE# �� ��) �-^( i MOVE IN/CLOSING DATE
.. i CFC/SEWER
GUAR.REV.
This application hereby request and authorizes the Utility to render water and/or sewage disposal
4 services to the premises,described above in accordance with the Utilities present or future rates, -
s" + LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay t
y. �-
e, � the Utility promptly for such services in accordance with'the established,rules'and regulations. •�
TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR,TRANSFERABLE.
SOCIAL SEC/
• t„.� ! ' CUSTOMER - , t ` ;-
i i. CJ� � L Y>� FED ID -7
4 SIGNATURE ✓ *
—i___—.NAME AF..SPOUSE..__ {3+ —__, _t_`'_ SPOUSE SOCIAL SEC.,
? jf tt # OFFICE USE ONLY' }C
�_ DATE RECEIVED 1 1 1 CASH CHK# l 1A RECEIVED`B'�' ; tA, Ti