HomeMy WebLinkAboutSLC Utilities Receipt+8ri'�'"� n t�(" Y°('Fk"t2*Yi. 8^^¢¢`. r�r' i^ c6T� ' tt?a".4 ">'o'�t. FN ty
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WATER: „- CO
ST LUCIE C Y UTII ITIES P O.'kv 72 FT. PIERCE''FL 34982
SEWER" RES
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NAME��1/
METER SZ t . M/F-
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/ SECURIT Y DEP
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`SERVICE ADDRESS I
-- SAMEDAYFEE
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SUBDIVISION`S�(�2,
LOT BLOCK
OVERTIME FEE
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EILLINGADDRESS�'�{�' G�uar'rilPcryr�3W"D
. METER INSTALL.'
CFC/WATER
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FPUA CFC
PHONE #.
.. MOVE IN/CLOSING DATE
„ CFC/SEWER
- GUAR:•REV -
This application herelig`request and authorizes the Utility to iendet waist and/or sewage disposal
:services
to premises described above m accordance widi_the Uhlthesprescot or future rates
LATERAL :Hiles
and reguis onS, which by refei_ence are made apart of this contract. Appli t agrees to pay, j
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the UGlity,promptly for such sernces m accordance with ttie established roles and regulations
t TOTAL'
CUSTOIv1ERSDEPOSITSARE'NONNEGOTIABLEORTRANSFERABLE`:'.
CUSTOMER t
SIGNATURE
59CIAL SEG �J r
FED
NAME OF SPOUSE
- '' SPOUSE SOCIAL SEC: '
ac OFFICE USECONLY,lal,10EIVED
DATE RECEIVEDGa CASH
BY�LU�/l
FEB % 6 j52.
ST Lucle County' _�
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