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TER OMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL 34982
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SEWER ✓ RES •
NAME Y..: e4/1.s5 2t
VMETER SZ. M/F r G, 2/1/A°/
ACCT.# (o I i / 7Ao
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SECURITY DEP SERVICE ADDRESS '"i 7T f"t� �(
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SERVICE FEE 3 Li 5 J
SAME DAY FEE /
SUBDIVISION -1?-tel, u^ gs sic/ cc/ LOT -7 BLOCK 47/0
OVERTIME FEE �7
c/6 METER INSTALL. BILL.IING ADDRESS ! z C ' A A-)u 10 rt-0 /l/�
am Q .50
CFC/WATER 3 j Co 0
FPUA CFC PHONE# ' v5 - v 0 MOVE IN/CLOSING DATE
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 present or future rates,
LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
the Utility rom tl for such services in accordance with the established rules and regulations.
I J ! 4, ID TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. '
CUSTOMER . SOCIAL SEC/ / __
SIGNATURE FED FED ID ;6 U� 5
i1NAME OF SPOUSE N/
/�' SPOUSE SOCIAL SEC.
OFFICE USE ONLY ; j ¢¢ /
( DATE RECEIVED 1 V CASH CHIC#dog/ / O 1 RECEIVED BY, 2Z
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