HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESf COMM
WATERLZ
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SEWER RES
METER SZ, MIRR
• f I;? SECURITY DEP
SERVICE FEE
S L LUCIE C(IUNTl' UTILITIES - P.O. BOX PIERCE EL 3411
NAME
ACCT. ##
SERVICE ADDRESS
SAME DAY FEE
OVERTIME FEE
METERINSTALL.
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CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
i TOTAL
CUSTOMER - t
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SIGNATURE -
NAME OF SPOUSE
DATE RECEIYED:
BILLING ADDRESS;
0t,Lt ;`IU E,
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
SPOUSE SOCIAL
;OFRICE 'USE ONLY
3 f RECEIVED BY ,�,/
'ASH__`,„ _ CHK # ;
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