HomeMy WebLinkAboutSTLUCIE COUNTY UTILITIIESWATER-
METER SZ.
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CUSTOMER(
SIGNATURE
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
0 OVERTIME FEE
1 ' METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
19, 00 TOTAL
NAME OF SPOUSE
DATE RECEIVED 1-1 111P1\
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ACCT. # 1 T (~ l�7 2)
SERVICE ADDRESS SrJ r t l C (� � r I a-e—
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of P,rrt� Ft -
SUBDIVISION _ L+�� I c� eup C-� LOT BLOCK /
BILLINGADDRESS V p
C;�L �ior(P ,y97�
PHONE # -72. 5 % -7 - V%D 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 SEC.
OFFICE USE ONLY
CASH CHK`# �� RECEIVED