HomeMy WebLinkAboutPAYMENT TO UTILITYam o
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I.
V WATER. Comm
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SEWER RES
37-9—METER SZ. M/F
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFCIWATER
ST. LUCIE' COUNT.YlUTILITIES - P.O. BOX 728, FT. PIERCE
NAME
ACCT.
SERVICE ADDRESS V les
3/9
SUBDIVISION (Ji' LOT BLOCK
BILLINGADDRESS % V�U C16CAWA Ll)-) I /X
FPUA CFC
PHONE —:S MOVE lN/CLOS li4G DATE
CFC/SEWER
GUAR. REV. This application hereby request a ! nd 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:
the Utility promptly for such services in accordance with the established rules and regulations.
TOTAL CUSTOMERS
DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMERI
SOCIAL SEC/
S GNA UREi > FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
T—
OFFICE USE ONLY
DATE RECEIVED �2'�//// CASH effK 4 RECEIVED BY