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WATER
COMM
SEWER
RES
METER SZ.
M/F
IRR
f
$
SECURITY DEP
/
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL:'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ I
TOTAL
CUSTOMER
SIGNATURE ,
NAME .OF SPOUSE
9`Z�I 03�lT
ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
NAME 1�l V � C
ACCT. # / 9 /
SERVICE ADDRESS r yJt o L
`Ff Pi z , v °�
SUBDMSION �' '� �trf LOT ! / BLO i G
NEW 4a
BILLINGADDRESS
PHONE # -MOVE IN/CLOSING DATE
This application hereby request and authorises 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/ i y �]
FED ID `Z (,d1
SPOUSE SOCIAL SEC.
OFFICE USE /i ONLY f
DATE RECEIVED ) 4P � CASH CHK # I t� RECEIVED BY