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V WATER COMM ST.LUCIE COUNTY UTILITIES-Pg.BOX 728,FT.PIERCE,FL 34982
SEWER RES
NAME '\d d' /t /add
METER SZ. M/F /1 ,/ f 33- 46 '
f�� J�/� IRR ACCT.# "GI S /j l�/�j
$ /6(J v SECURITY SERVICE ADDRESS K-57
,'72, ' / t)t.
SERVICE FEE / -Y. / /ele <8•540`,9, ___,
SAME DAY FEE
SUBDIVISION - 7 LOT BLOCK ��
OVERTIME FEE
.�U?�5' ``ll
�v METER INSTALL. BILLING ADDRESS_c_cd
CFC/WATER
FPUA CFC 77a 5g-�Z�
PHONE# + OVE IN/CLOSING DATE
CFC/SEWER
This application hereby request and authorizes the Utility to render water and/or sewage disposal
GUAR.REV. services to the premises described above in accordance with the Utilities present or future rates,
/l LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
$ 3'0• V 6 OTAL the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. 1
SIGNATURECUSTOMER �- /i /'i Z, FED ISCIAL D SU 78 ,W s'
NAME OF S'0 SE SPOUSE SOCIAL SEC.
OFFICE USE ONLY �(�j�
DATE RECEIVED II O CASH CHK# 7 ' RECEIVED BY IK:=L__.,,`--L
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