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WATER COMM I ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
SEWER RES
METE SZ. M/F
�� IRR
SECURITYDEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
' FPUA CFC .
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
NAME
ACCT. #
SERVICE ADDRESS
3461,
SUBDIVISION �-�- LOT BLOCK
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BILLI GADDRESS % it//6.bjl d ��
PHONE #-3;11 - ���� MOVE INICLOSING 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.
CUSTOMER SOCIAL SEC/
SIGNATURE FED ID i!
NAME OF SPOUSE ' ?, C' `L� SPOUSE SOCIAL SEC.
n OFFICE USE ONLY
DATE RECEIVED - I tr� �i CASH CIIK-�# �� RECEIVED BY