HomeMy WebLinkAboutSLC Utilities Receipt,. � WATER -`
COMM
ST. LUCIE,CQUNTY UTILITIES , P.O.-.BOX 72S F.T, PIERCE; FL MOST
RES
NAME 1 1
s METER SZ
�M/F
� _
$ `
SECURITYDEP
SERVICE ADDRESS
SERVICE FEE
+� SAME DAY FEE
^
SUBDMSION
-
OV,,E FEE
METES
BILLING ADDRESS
INSTALL
FPUA CFC
r
PHONE ' # MQVE IN/CLOSING DATE
GFC/SEWER
GUAR REV .,
}
This apphca, on hereby request and suthor�zes the Utility to;ender water and/or sewagel disposal
,•
r
rbices to premises descn a ui accordance with;the Ut
se the bed abov ihties present or future rates,
`+
LATERAL
ntles and regulations, which by reference are made a part=of this contract Applicant agrees to'pay
-� .
TO'1'A4
the: Utility promptly for such services ins accordance with the established ryles Yand ..regulations .`
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE ,
:_
SIGNATURE`7.
SOCIAL SEC/
ID
FED r
NAME OF SPOUSE.
SPOUSE SOCIAL SE.0
.S
Al OFFICE USE ONLY
DATE RECEIVED
CASH CHK # RECEIVED