HomeMy WebLinkAboutSLC Utilities ReceiptWATER
COMM
✓
SEWER
RES
METER SZ.
M/F
IRR
50,
$ C l Q
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
ICJ DO
METER INSTALL.
` l�lJ • ( —,%
CFC/WATER
4 (f; (C " 0C)
FPUA CFC
1,200 0 Q a
CFQSE�R
("iUAR. REV.
rl
$ t 4. D
TOTAL
CUSTOMER
SIGNATURE/Z/j
ST. LUCIE COUNTY UTILITIrES - P.O. BOX 728, FT. PIERCE, FL 34982
NAME �t� C
ACCT. #
SERVICE ADDRESSo�. ()! �(,� %� 16_C'1
SUBDIVISION ! f SLto fj e LOT —BLOCK (�
BILLING ADDRESS
PHONE
IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage dispos:
s ices to the premises described above in accordance with the Utilities present or future rate:
les and regulations, which by reference are made a part,of this contract. Applicant agrees to pa
the Utility promptly for such services in accordance with the established rules and regulation. -
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ t FED ID
NAME OF SPOUSE 1 &! SPOUSE SOCIAL SEC.
C� OFFICE USE ONLY r�
TIEWCEIVED li CASH CHK # 61110 / RECEIVED BY