HomeMy WebLinkAboutSTLUCIE COUNTY UTILITIES/70
WATER S.OMM
SEWER
S METER SZ. MIF
IRR
$ _Sl�� 1(q SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
tly(00 TOTAL
CUSTOMER
SIGNATURE
NAME .OF SPOUSE
DATE
NAME ✓ L V ' "
ACCT. #
SERVICF
SUBDIVISION
—JiLL6�/
BILLING ADDRESS
116 _BLOCK
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 �fU
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
CASH Gfli�#F. RECEIVED
WATER COMM
SEWER _Y1_ RES
METER SZ. M/F
QIRR
$ V SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE.
METER INSTALL. '
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR REV.
LATERAL
00
TOTAL
CUSTOMER
SIGNATURE
❑!!
JUL 3 0 2018 -
ST, ,Luck County, Permitting
NAME J/ /L- / (mod U Q
ACCT. # `U / 61eq
SERVICE ADD S!
SUBDIVI ON / LOTBLOCK
BILL GADDRESS
HONE # \ MOVE IN/CLOSING DATE
This application hereby request andkuthoriaes the Utility to render water and/or sewage disposal
services to the premises described ab ye 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 3�,_ru-�79a
NAME OF SPOUSE
SPOUSE SOCIAL SEC.
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