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_WATT R , /COMM ST.LUCIE COUNTY UTILITIES—P.O.BOX 728,FT.PIERCE,FL 34982
SEWER RES NAME
Jr V1ETER SZ. M/F ACCT.# q r) J D
IRR , »Yr :� � �?c,y . �•'�Gc C'- E{�'"
"SECURITY DEP - SERVICE ADDRESS
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- SERVICE FEE
SAME DAY FEE ��
SUBDIVISION LOT BLOCK
OVERTIME FEE __
CJ C METER INSTALL. BILLING ADDRESS MPJ e b e C11-C?�`�C( fid an h r
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CFC/WATER
FPUA CFC PHONE# - �' 4 l " 'R'S C4 MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby request and authorises 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
. ) ti the Utility promptly for such services in accordance with the established rules and regulations.
-) TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOM ER SOCIAL SEC/,
`�:. �1., f..���s; FED]D �' `- '
SIGNA. ,J
NAME 01='.5k-Qi�tSE y-S'" f t `i P_' CO-S SESOCIAL SEC. V /�� " `�1'
41
- / , OFFICE USE ONLY
DATE RECEIVED (���r � c� -CASH CHK# RECEIVED BY
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