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WATER COMM ST LUCIEaCOU1�lTY UTILITIES P O,BOX 7218,FT PIERCE FL 34982 ifl 1 ,
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�} GUAR VREV _ Tliis apphcationshereby request and authonzes the Utility tarender water and/or sewage disposal
services to.the premisesdescnbedaabove m accordance with the Utilities precentor futuie rates,;
.LATERAL rules and regulations,which by reference are made a part of flus contract Applicant agrees to pay
r the Utility promptly for such services m accordance with the established r61es `and regulations a
CUSTOME AItE N TRANSFERAB
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NAME OF'SPOUSE = SPOUSE SQCIAL SEC
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'DATE RECEIVED I CASH CHK RECEIVED BY tI .
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