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HomeMy WebLinkAboutSLC Utilities ReceiptV1- WATER SEWER C6 !/ RES ` T METER SZ. M/F 0C) IRR SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE 3©Jcr-� METER INSTALL. �CPO CFC/WATER / `7 6 ( - FPUA CFC 1 CC CIO CFC/SEWER GUAR. REV. o� CO BATEI RI'. CUSTOMER SIGNATURE NAME OF ST. LUCIE COUNTY UTILITIES - P.O% 728, FT. PIERCE, FL 34982 NAME �iea AJbl'E 1 /V t-= ACCT. # SERVICE ADDRESS 6c�) A�f SUBDIVISION WGrrPA'fS%G�/W LOT BLOCK L BILLING ADDRESS �(� ✓/� k / Q/�}S 00 ✓l'I �%PPP7" Kf C PHONE # _�a� 76257 -6-6'7S MOVE IN/CLOSING DATE P�s application hereby request and authorizes the Utility to render water and/or sewage disposal is 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. SOCIAL �SF�Cj/ ID �C r 2-3U 2-O FED SPOUSE SOCIAL SEC. OFFICE USE ONLY DATE RECEIVED 7/401 CASH CHK # �'lgN(CU RECEIVED BY /