HomeMy WebLinkAboutUtility Company Approval / WATER COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL 34982
✓ SEWER RES NAME Cyr C?-n
METER SZ. M/F ACCT.# —77` r
]RR
$ 1 SECURITY DEP SERVICE ADDRESS 42j e—fo
SERVICE FEE
SAME DAY FEE
SUBDIVISION LOT 4 BLOCK
0
OVERTII4IE FEE
M BILLING ADDRESS
METER INSTALL.' D 11
CFC/WATER
FPUA CFC PHONE# MOVE IN/CLOSING DATE
/D W CFC/SEWER
GUAR.REV. This application hereby request and.authorizes the Utility to render water and/or sewage disposal
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
the Utility promptly for such services in accordance with the established rules and regulations.
$ � TO AL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOME SOCIAL SEC/
SIGNATURE — FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
r OFFICE USE ONLY
DATE RECEIVED���f CASH CHK# RECEIVED BY�.