HomeMy WebLinkAboutFILLED LAND AFFIDAVIT 6-16-17ATER COMM ST. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT. IPIERCE, FL 34982
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SUBDIVISION .-�" LOT .9 BLOCK
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OVERTIME FEE
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CFC/WATER
FPUA CFC PHONE*� % '� ` boo _ ? ?' CiU MOVE IN%CLOSING DATE
CFC/SEWER
GUAR. REV. 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, -
LATERAL rules and regulations, which by reference are ma&a part of this contract: Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
$ TQTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL, SEC/
SIGNATURE FED ID I
NAME. OF SPOUSE
SPOUSE SOCIAL SEC.
DATE RECEIVED . U
OFFICE USE ONLY ��
_ CASH CHK # �:0_ . RECEIVED BY