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WATER COMM ST,LUCIE COUNTY UTRSTIES-P.O.BOX 728,FT.PIERCE,Fl,34982
SEWER RES NAMEt � . .S—
� METER SZ. MI
IRR ACCT.# �(
SECURITY DEP SERVICE ADDRESS '� T n++ KC-4
SERVICE FEE
SAME DAY FEE
SUBDIVISION � -\ OD%W LOT ✓ BLOCK
OVERTIME FEE r�
1 {� BILLING ADDRESS I, r �
METER INSTALL.' t T'
"! 3 0� �n
`1 CFc/wATER �.. w�a._��..�G \ � c� �tt�� C..� L(D�"Yi i
FPUA CFC PHONE#Z�1 f '�ag�(0 MOVE IN/CLOSING DATE .I
CFC/SEWER
g_a.QO 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 ori future rates,
i,•t �.f D LATERAL rules and regulations,which by reference are made a part of this contract.Applicant agrees to pay
the Utility promptly for such services in accordapce with the established rules and regulations.
$ TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC!
SIGNATURE
�., FED ID I
NAME.OF SPOUSE SPOUSE SOCIAL SEC. '
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED BY
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