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K COMM ST LUCIE COUNTY -UTILITIES 'P.m-BOX-728 FT PIERCE FL 34982
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SEWER NAME I
METER SZ 117/F
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SERVICE ADDRESS'" IJJ
$ ( SECURITY DEP
SERVICE -FEE
$AME DAY FEE 'D P
SUBDMSIONAU
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O\/ERTIME FEE
BILLING ADDRESS: J
METER INSTALL:. r
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64
CFCI_ A ER
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PHONE# 321 k� 3VIOVE IN/CLOSING DATE
FPUA" C L �3 '
This :application hereby request and authonzet � Utility to render water and/or sewage. disposal .
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AR --REV ; servicesao "the premises described above m accordance with;the Utilities present or future rates;•...:
L ules; and regulations; which by reference
rare made apart of this contract Appitcant agrees to pay
the Utility promptly for such. services in accordance with the established rules and regulations
,: O O TOTAL CUSTOMERS DEPQSITS ARE NONNEGOTIABLE OR TRANSFERABLE
CUSTOMER 1
SIGNATURE G.L.
NAME OF. SPOUSE
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