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SEWER
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IWMETER SZ.
M/F
IRR
$ -DID SECURITY DEP
61IfZ
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
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FPUA CFC
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LATERAL
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s.
ST LUCIE•COUNTY UTILIT�I(ES�- P.O. BOX 728, FT. PIERCE, FL 34982
NAME
ACCT. #
SERVICE ADDRESS -P) S(5k, (!Wes one (�
4m�-- P wte I-L- 34gls
SUBDIVISION LOT 6,BLOCK
BILLINGADDRESS ,4� -() - Pa&m 19 F -
.D D UA A Ar-U-r �X--�- 3 �, %C1
PHONE # 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 SOCIAL SEC/ •� t (_r �(� .
SIGNATURE FED ID 'CAP 1
NAME OF SPOUS SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED /-
V
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RECEIVED BY /`