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=• kI ST LUCIE COUNTY YJTILITIES P O BOX 728 FT+PIERCE;FL 34982
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SEWER RES
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NAME G1 1 �;: d- f t''-� J 4
METER Z M/F d
a. IltR ACCT
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$ 'r(�C7 'SECURITX DEP SERVICE ADDRESS
SERVICE FEEt '`� �f .
'•SAME'DAY FEE '� `:. � � ,'
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SUBD SION LOT BLOCK
OVERTIME FEE
`- METER INSTALL BILTiNG`"ADDRESS I� � CQ t
CFC/WATER
-FPUA CFC ff f
7. PHONE#: 'V� I ' MUVE IN/CLOSING DATE
CFC/SEWER
GUAR:'REV
This applcatton hereby request and authorizes the IJtthty to render water and/orlsewage disposal
services to the preQuses de'scnbed above u accordance v�nth the Utilities present or future rates,
rs LATERAL Hiles and regulations,which by reference are made a part of_tlus contract Applicant agrees to,day .
the Utthty;promptly for such s�rv�ces accprdance wrth'the established rules and;regulations
TOTA
' CUSTOMERS DEPQSITS ARE NON NEGOTIABLEEOR TRANSRERABLE
CUS?OMER �r SOCIAL SEC/
1
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SIGNATURE r / FEDID t �T
NAME OF?SPOUSE :' !
SPOUSE SOCIAL SEC
E ONL
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O FICE U Y
c` ,DATERECEI�!ED e... CASH RECEIVEDuBY
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