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HomeMy WebLinkAboutUtility Company ApprovalYA�ER COMM ZVER RES U © IV --MR RL. M/F IR.R S SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTALL. • CFC/WATER FPUA CFC CFC/SEWER GUAR REV. — �C 7 LATERAL TOTAL %-U6-1rOMER U IIXI ES --P.O. BOX 728, FT. PIERCE. FL NAME r- 1Vk UUV k Qj- ACCT. # 5� SERVICE ADDRESS a-193 SUBDIVISION_� LOT PHONE # — / f )--�% f Y BLOCK IN/CLOSING DATE 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, 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 NON NEGOTIABLE OR TRANSFERABLE. SOCIAL SEC/ jj� FED ID \ I s b� , O) lU q SPOUSE SOCIAL SEC. Oo'� r- 2:2, OFFICE USE ONLY