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HomeMy WebLinkAboutUtilities Application11'/ WATER ✓ SEWER Pt METER SZ. COMM ST. LI7 RES NAME .Mx MR / / '7► D SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE 6 �j Q u ° METER INSTALL.' CFCIWATER FPUA CFC CFC/SEWER GUAR REV. LATERAL TOTAL CUSTOMER SIGNATURE NAME OF SPOUSE ACCT. # , 9 q !�699q SERVICE ADDRESS t$ / /`7 i I jj��,,,, � % SUBDIVISION 1/(_��.6�L �f 1`dw Gt/ LpT -BLOCK BILLINGADDRESS / 7y Y ' d1b 1VZ N PHONE #L47, 3 - 69 l c) � MOVE IN/CLOSING DATE This app anon hereby request and authorise a 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/ FED ID SPOUSE SOCIAL SEC. nhhqOFFICE USE ONLY DATE RECEIVED / CASH CHK #_/ If WATER COMM SEWER -// RES f r METER SZ. M/F � IRR $ j'! k4 — SECURITY DEP SERVICE FEE SAME DAY FEE 1 OVERTIME FEE l 14 METER -INSTALL.' CFCAVATER FPUA CFC CFC/SEWER GUAR. REV. LATERAL TOTAL RECEIVED BY, RECEIVED _................. JUL-4.4 -2021 ST. Lucie County, Permitting ST. LUCIE COUNTY UTILITIES - P.O. BOX 928. FT. PIERCE. FL 34982 NAME ` Nat h '" U�' 991 ACCT. # - if SERVICE ADDRESS 45(0� L . A SUBDIVISION t.C:'�/l_ LOT + BLOCK BILLING ADDRESS 4A /� PHONE #4 -T Q- L493-- © I V2, MOVE 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. CUSTOMER S 73 SIGNATURE C ,�� FED IDL NAME OF SPOUSE SPOUSE SOCIAL SEC. -�J (VJ OFFICE USE ONLY a s-L ! JJJDATE RECEIVED / CASK CHK # i� RECEIVED BY��