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COMM
SEWER
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SECURITY'DEP
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SAME DAY FEE
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OVERTIME FEE
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CUSTOMER
SIGNATURE /
NAME OF SPOUSE
`,DATE RECEIVED
AN) FPo r�. , E �o-<,'.�> c ,
ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
NAME (—T�
ACCT. # `Y �l5 L4
SERVICE ADDRESS WA Q o -e e o e
SUBDIVISION e P i-k LOT QQ) BLOCK
BILLING ADDRESS`���J`)L�
PHONE # '� I I -' �� 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.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL
OFFICE USE ONLY (JoL Q
I CASH CHK #`1 N
RECEIVED