HomeMy WebLinkAboutUTILITIESt.:'-"' WATER
Z SEWER
METER SZ.
1
COMM I ST, LU
RES NAME
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
--7 j LATERAL
TOTAL
CUSTOMER
SIGNATURE 1 !
NAME OF SPOUSE
- P.O. BOX 728. FT. PIERCE, FL 3
SUBDIVISION l .� LOT ` " . r✓� BOCK
BILLINGADDRESS ^ 1 `-t ,3b Aj
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.
SOCIAL SEC/ -� / /
FED ID �� ��+ `7 Cy C. i j &
SPOUSE SOCIAL SEC.
OFFICE USE ONLY 1
DATE RECEIVED / / CASH C� 0" c- RECEIVED BY
WATER
_ SEWER
METER SZ.
COMM I ST. LU
RES NAME
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE —�
NAME OF SPOUSE
ACCT. #
SERVICE ADDRESS
-:::J11q!t V r
SUBDIVISION �c
BILLING ADDRESS �l
- r.V. DV11 /401 K A. KJLM JNVCI, X-L JY70G
1 t i 4q
LOT Ws-,"l—BLOCK
� � k) E�;-
olA ^
ic)-7
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.
SOCIAL
FED ID SEC/ g _4 t^ Q 69
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED /1-� GAS>3n V t # RECEIVED.B