HomeMy WebLinkAboutWater receipt WATER° COMM ST LUCFE COUNTY UTILITIES P O'.BOX Z28,FT PIERCE,FL 34982
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- SERVICE FEE
_ SAME,DAY FEE 1't`
SUBDMSION LOT_! _BLOCK
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METER INSTALL
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FPUA CFC PHONE# Q`t V rZci MOVE IN/CLOSING DATE
- CFC/SEWER
GUAR REV,. This applicathon liereby request and authorizes the<Utthty to render Water and/or sewage disposal'.
_ servrces to the pemises described above in accordance with the Utihhes.present or future:rates,_:'
LATERAL rules andregulations,which by reference:are made a part ofahis contract Applicant agrees to.pay.
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i1i-,Utility promptly for such services m.accordance with;the estabhshed rules and'regulafions
TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE
CUSTOMER n - SOCIAL SEC/ -
SIGNATURE "" C~d UU' FED-ID
NAME OE SPOUSE `-^ SPOUSE SOCIAL SEC
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OFFICE USE ONLY j
DATE RECEIVED1 CASH CIIK#Cr RECEIVED BY,