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COMM
ST. LUCIE COUNTY UTELITIES - P.O. BOX 728 FT. PIERCE, FL 34982
SEWER
RES
NAME
METER SZ.
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SERVICE ADDRESS U
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SERVICE FEE
SAME DAY FEE
SUBDIVISION(/ ub t� �� E� LOT_.BLOCK
OVERTIME FEE
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METERINSTALL.'
BILLING ADDRESS
CFC/WATER
FPUA CFC
PHONE # MOVE IN/CLOSING DATE
CFC/SEWER
This application hereby request and authorizes the Utility to render water and/or sewage dispo;
GUAR REV
services to the premises described above in accordance withthe'Utilities present or future rats
..
LATERAL
rules and regulations, which by reference are made a part of this contract. Applicant agre-,es. to p.
in with the established rules and regulatioi
TOTAL
the Utility promptly for such services accordance
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOIv1ETt` ` .
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SOCIAL SEC/
FED ID
NAIvIE'OF SPOUSESPOUSE SOCIAL SEC.
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ICE USE, ONLY r"
... _ CHK # RECEIVED BY
DATE RECEIVED. / ! ,� , �1 CASH _ _
RECEIVED -
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ST. Lucie County, Permitting