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WATER COMM
SEWER RES
METER SZ. M/F
NAME OF
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
NAME Of�- UkC
ACCT.
SERVICE
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SUBDIVISION =Yl OM:Q'n Y- elr E5 —GCe.S LOT BLOCK 13
BILLING ADDRESS aO i SUJ T0rkQk-L -XC-1 - 6Avd `iiSL- )E\ 349$ LA
EMAIL
PHONE# 11D 2491 ODKG) MOVE IN/CLOSING
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 or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
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SOCIAL SEC/FED ID_
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED
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M/F
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IRR
5106 SECURITYDEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
3 00 METER INSTAL
ST LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
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ACCE
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SUBDIVISION =n Dxaln rl veX 1G11GS LOC a 3 BLOC(-2
BILLING ADDRESS aOI SUI��OC+�J'i I-(AGI2 PoXVCt -k-SL f-I S49,3L1
CFC/WATER I EMAIL
FPUA CFC
CFC/SEWER
L$iL1[a.]
LATERAL
V U TOTAL
10, "p5L ?Y_C
PHONE# _I-7a- 2_401 009CJ MOVE IN/CLOSING DATE
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 or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
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SOCIAL SEWED ID_
NAME OF SPOUSE SPOUSE SOCIAL SEC,
OFFICE USE ONLY
DATE RECEIVED 5118 U CASH -€##f# Iy RECEIVED BYb ZI,&d