HomeMy WebLinkAboutUtilty FeeV WATER COMM— f ST. LUCIE COUNTY UTILITIES .- P.O. BOX 728, FT. PIERCE, FL.34982
r SEWER RES
METER SZ. M/F
IRR
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
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METER INSTALL.
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FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
I � ' TOTAL
NAME-. ,,11 r-A O , 6 r
ACCT. # 1 S J
SERVICE ADDRESS ��� Cr (mil'
SUBDIVISION-1 t:f- . LOT / 44 I S BLOCK /
BILLINGADDRESS4 21
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PHONE # f �'S �r " 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•presentpr 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 1, / SOCIAL SE I
SIGNATURE' FED ID �c J D... -
r1 1 �,• ; ! �� SPOUSE SOCIAL SEC. F �� '?�- (:,1- r �l+ �% �I
NAME OF SPOUSE "},� itwT�-,nl �/. I/; •_��_
OFFICE .USE ONLY
DATE RECEIVED CASH - CHK.#- RECEIVED BY,,, `�