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WATER COMM
SEWER RES
METER SZ. M/F
IRR
$ C`/�D' 0(1
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
L METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
ST. LUCIE COUNTY UTILITIES - P.O. BOX
NAME ( A-LA"1,11i /G I`L} 4rl
ACCT. #
SERVICE
1 a
SUBDIVISION LOT
BILLING ADDRESS
-F
or
D BLOCK
_'? Kldt4
P ONE . )OS--- MOV I LOSING DATE
` Gel" x �.1�
This application hereby request and .authorizes.the Utility to render water an or sevAge 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 NONNEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ ^ 3DIMFEDID Q
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK ff RECEIVED BY