HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESRECEIVED
.. APR 0 6 �
2018
Pertnittfng ®ePartment
Jt: W@I@ tounty
;.
ST<LUCIE COUNTY UTILITIES P O BOX 728 -FT. PIERCE `FL`34982
SEWER :
pS
,
NAME G� 1/
METER SZ
t)'MO )
._.—
$
SECURITY DEPI
SERVICE ADDRESS (�
..
SAME FEE
DAY :
SUBDIVISION ' LOT �.�
OVERTIME FEE.
BL.00IF
BI-LINGADDRESS
METER'INSTAI;L.-,
C,FC/WATER
FPUA CF.0
de
PHONEMQVE, IN/CLOSING DATE
GUAR REV
This?application hereby request and'authonzes the Utility to.render wafer andlor sewage d�sposal'f
I ATERAL
services to the premises described above ui accordance with the Utilities present orjfuture;rates
rules and regulahons.wluch;Uy reference are;made a part of this contract Applicant agees
Uhhty
CUSTOMER' r �`� " '
TOTAL .
the to.pay .:
promptly.,forrsuch;services m accordance,with the;estabhshed rules and;regi�lations.' CUSTOMERS DEPOSITS ARE NON NEGQTIABLEOR TRANSFERABLE`: ' a
.SIGNATURE'r �-
_
SOCIAL SEC/
c = 3
'FED ,,�--
NAME ;OF SPOUSE
;SPOUSE SOCIAL SEC..
OF
NLFICE U E O �-! S Y .
DATE RECEIVED 3 ij '- CASH ` CHK #� RECEIVED
BY
!9
i �- , Y� � � x � 1 „ "t-.....,tT'r•s� Y Tt 1 K t i d 4J� ,.1'+r
ST LUCIE COUNTY UTILITIES PO .BOX 728 F,T : PIERCE FL 34982 , .
04-05-2018Count10:58�12
3 Y'
NAME: .o iJ�JC'1i
+ f
ACC f
IT66HOMES
�
BUCHANAN DRASSOCAE
FORT PIERCE
SE
CEADDRE4508
FL 34982
; F
Amount Tendered: 519.00
RE SUBDIVISION
_ f BLOCK
Amount Paid: 519.00
BE.
BILLINGADDRESS d
Change Due: 0.00
Thank You
Q
PHONE # �MOVB ili/CLOSIrrG DATE
User ID: MURRAYA
.
,-
This application hereby request""and authorizes the Utilitq to render water and/or sewa a disposal.,
•:
services to the.p,id ises described above in accordance with the Utilities presen't.or future rates;
LATERAI °'''
rules and regulations, which by reference are made a part:.b this`contract Applicant agrees to pay
TOTAL
the Utility promptly for such services in accordance wikh the estabhslied rules.iand tegulafions.
CUSTOMERS;DEPOSITSARE,NONNEGOTIABLEQRTRANSFERABLE .`
CUSTOMER
SIGNATURE �� s� �
r
SOCIAL SEC/
FED IDi
,�
NAME -OF SPOUSE
SPOUSE SOCIAL SEC:
DATE RECEIVED Z
:OFFICE USE ONLY
CASH CHK #si'`
RECEIVED BY�