HomeMy WebLinkAboutSLC Utilities ReceiptRECE1`":►D FEB 09
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ST. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT:'PIERCE FL 34982
SEWER - RE
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NAME
METER
' ACCT..# (19
39. :D DEP
SERVIGEADDRESSs
SECURITY
SERVICE FEE
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SAME DAY FEE
SUBDIVISION. W14iZ.'2�`a�� LOT:' SS :BLOCK.:• � 1
OVERTIME FEE
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• BILLING ADDRESS• � .sn
METERINSTALL.' `•
CFC/WATER
FPUA CFC
PHONE A#1.7 7 2-6 v -75f MOVE IN/CLOSING DATE
CFC/SEWER .'
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This application hereby request and authorizes the Utility to render water and/or sewage disposal
GUAR. REV.
services to the premises described above in accordance with the Utilities present or future rates,.
LATERAL
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay .
h s in accordance with the established rules and regulations.
CUSTOMER
SIGNATURE
NAME OF SPOUSE
DATE
the Utility promptly for suc service
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ ,n
FED. ID
SPOUSE SOCIAL SEC.
"OFFICE USE ONLY ^�
CASH CHK #/QRECEIVED BY.