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WATER COMM ST.LUCIE COUNTY UTILITIES-P:O.uny 7.2%_K1 P=CE FL 34982
SEWER RES
METER SZ. NAME
M/F _
MR 1ACCr.#
$ _SECURITY DEP SERVICE ADDRESS -t �—
SERVICE EEE
SAME DAY FEE --�^
OVERTIME EEE SUBDIVISION qtr� LOT BLOCK
J n�t� METBRINSTALL.' BII.LINGADDRESS
CFCJWATER (24S��COD9Vr
FPUA CFC PHONE� �20)
MOVE IN/CLOSING DATE
CFC/SEWER
GUAR REV. This aPPiicationn heriuy requestand thoriz s the Utility to render water and/or sewage disposal
services to the premises descn'bed above in accordance with the Utilities present or future rates,
LATERAL miles and regulations,which by reference are made a part of this contract.Applicant agrees to pay
$ �� a�� TOTAL the Utility promptly for such services in accordance with the established Hiles and regulations.
CUSTOMER
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE,
SIGNATURE4� SCa '�f i FED ID 813C4'
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY..
DATE RECEN CASH CHK# RECENEU BY' _
f
L U 0fEN C®11 N Tf U T,LH
d
� } r c� CCS .
JUL 13 �a�G�
ST.Lucie
County,Permitting
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