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ST: LUCIE COUNTY'UTILITIES -,P.O. BOA 728 FT. PIERCE FL34982
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$ �C SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
SERVICE ADDRESS 5Q 3 ` Ab S+
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BLOCK
SUBDIVISION--- LOT r
PHONE #
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
the Utility promptly for such services in accordance with the established rules and regulations..
CUSTOMERS DEPOSITS ARE -NON NEGOTIABLE- OR TRANSFERABLE.
CUSTOMER � � RUC ID SEC/
SIGNATURE
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY