HomeMy WebLinkAboutlot56UtilitiesATER COMM
__EWER RES
S� METER SZ. M/F
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL,'
CFClWATER
FPUA CFC
CFC/SEWER
GUAR REV,
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LATERAL
TOTAL
CUSTOMER
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SIGNATURE
NAME OF SPOUSE
av6 �-- 0 S -
r LITIES - P.O. BOX 728, FT. PIER
NAME
ACCT. #
SERVIC AD RESS
40- P10,4cv
Su�IaIVI�zaN,� L��u�7 n �LOx �✓ BLocx
13ILT&A
ADDRESS0b ) W_) 3 D90 9
PHONE # 3D I 13- 3 '' qq 7cJOVE INICLOSING DATE
This application hereby request and authorizes the Utility to tender 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.
SOCIAL SECT ``''
FED ID _ `7`
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH �1# , - RECEIVED BY