HomeMy WebLinkAboutUTILITIES/\ SEWER
5 W METER SZ.
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$ /®ly, 06
rust i NILHCE, FL 34982
07r1!�U18 12:52:15
III( SALE
Card H
XXXXXXXXXXXX7474
19
929
11'lUG! .:L
19
Approval Code:
070069
Entry MAW:
Mjnual
Mode:
Online
Tax Arnount:
$0,00
Cust Code:
Avs Code:
NNN
Ward Code:
M
SALE,=!i IIOUNT $176.25
NTY UTILITJI/E'S - P.O. BOX 728 FT. PIERCE FL 34982 7-0 l
(p f7V I/ — 6c),37—
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LOT BLOCK
'vi-w /Ve-
R 3c�_9a7
MOVE IN/CLOSING DATE
�n hereby request and authorizes the Utility to render water and/or sewage disposal
premises described above in accordance with the Utilities present or future rates,
�ations, which by reference are made a part of this contract. Applicant agrees to pay
tmptly for such services in accordance with the established rules and regulations.
'P DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE (%
NAME OF SPOUSEy "
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH GiA'# ° - RECEIVED BY
WATER
• Comm
SEWER,
RES'
METER. SZ.
M/F
IRR
SECURITY DEP
SERVICE FEE
SAMt,'DAY FEE
OVERTIME FEE
MEIBICINSTALL.'
CFCAN�TER
FPUA CC
CFC/SEWER
GUAR.; REV.
LATERAL
TOTAL
CUSTOMER
SIGNATURE
(_�
NAME OF SPOUSE
ST. L�UCIE.G,6,6TY UTILITUS - P.O. BOX 728, FT.
NAME
ACCT. #
SERVICE ADDRESS
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CTTIATMVKTOM
BILLINGADDRESS IJK
-9
PHONE
3
This application hereby requegi`ii
§,.ervices to the premises describe(
,bg
J';
'rules and regulations, which by rd'
iv
the. Utility promptly for such so�
CUSTOMERS DEPOSITS AREJ
.1;
FED ID
E, FL 34982
LOT 1;'BLO(
MOVE IN/CLOSING DATE
I authoriies the Utility to render water and/or sewage disposal
above in accordance with the Utilities present or future rates,
-rence are made a part of this contract. Applicant agrees to pay
,pes in accordance' with the established -rules and regulations.
ON NEGOTIABLE OR TRANSFERABLE.
SEC.
OFFICE USE ONLY
DATE RECEIVED CASH Of ff-# -.14 1 RECEIVED BY