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WATER OMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL 34982
SEWER RES
NAME L-)17..0A E2-411 / r c w ►A
METER SZ. /9-07/
7/ _ s i
ACCT.#
4OD r
$ `' SECURITY DEP SERVICE ADDRESS c 0 IltR
S 6- i'1 If o f Oa k
SERVICE FEE
SAME DAY FEE
SUBDIVISION .En L1.RA'tr t . 4 LOT • BLOCK
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�-yy OVERTIME FEE
METER INSTALL.
Lt"Vf� `7 BILLING ADDRESS C i O G U C L o}7 r / I.-
II I
CFC/WATER -�- _ f..Q sZ FL 3 (f 4 8,
FPUA CFC PHONE# J= 2- - MOVE IN/CLOSING DATE
CFC/SEWER 9/)/-- ,r�G,/3
GUAR REV. This application hereby llre4uestt 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
$ L)q, .� 00 TOTAL the Utility promptly for such services in accordance with the established rules and regulations.
—/ ! CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMERj_____,A,..- SOCIAL SEC/SIGNATURE f lJ i 4 FED ID "
NAME OF SPOUSE •�F 1
, R SPOUSE SOCIAL SEC.
• j� OFFICE USE ONLY /�q ��
DATE RECEIVED[U CASH CHK# �OQ RECEIVED BY gM WV I(
inns -+'9`;'"v, v �'�'"7:4_ w�,,y"'
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4:;,:l*:,,,:., x,. "ter
Exterior Features
View: - RoofCover: SD- Dim Shingle RoofStruct: GA- Gable
ExtType: HC=- HC- YearBlt: 1978 Frame: -
Grade:
StoryHght:
C C- Ef YrBlt: 1978 PrimeWall: WS
Wood/Sheath
0010- 1 Story No.Units: 1 SecWall: -
Interior Features
BedRooms: 2 Electric: MX-MAXIMUM PrmintWall: DW-Drywall '
FuIlBath: 2 HeatType: FHA-FrcdHotAir AvgHt/FI:
1/2Bath: 0 HeatFuel: ELEC -Electric Prm.Flors: CU -Carpet
%A/C: 100 %Heated: 100 %Sprinkled: 0
Special Features and Yard Items Land Information
Type Y/S Qty. Units Qual.Cond.YrBlt. No. Land Use Type Measure Depth
FEN4 - CHAINLINK 4' Y 1 860 AV AV 1978 1 0100-SF Res BI -Front Ft 132 300
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND
IS NOT WARRANTED.
htip://www.paslc.arg/prc.asp?prclid=340260601210007 10/14/2011