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St.. Lucie County - PCIS
04-19-2018 03:44:16
RY4AN1H055�6369'i
FORT PIERCED .LAKE CIR,.
FL 34951
Amount Tendered: 608.00
Amount Paid:, 608.00,
Change Due: .0.00
Thank -You
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5 1. Lucie CeiAnty, Permitting .
ST. LUCIE COUNTY UTILITIES P.O. BOX 728, FT. PIERCE, FL 34982
NAME`` �iJ` 'r\ \ b
ACCT. # t j 0 �1(J - ! -
SERVICE ADDRESS''-
SUBDMSION D LOT —7 BLOCKI III
'
BILLING ADDRESS � li\ };1 1 'R,- 1 o
�_�ao -,360 MOVE IN/CLOSING DATE
User ID: MURRAYA
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,
LATERAL rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
9 the Utility promptly for such services in accordance with the established rules and regulations.
$ 6:) n S TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER �A� f (,� SOCIAL SEC/ -
SIGNATURE V " �. '`--i - l�{FED'ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
f OFFICE, USE ONLY 2
DATE RECEIVED '4-19"i CASH CHK # Q 3�RECEIVED BY _/