HomeMy WebLinkAboutST LUCIE COUNTY UTILITIES1y WATER
x SEWER
METER SZ.
yr, C, C) A q ,(,
�1, L
i M
RES
M/F
IRR
SECURITY DEP
_ SERVICE FEE
_ SAME DAY FEE
_ OVERTIME FEE
METER INSTALL.
_ CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
_LATERAL
TOTAL
ACCT. # ((/ / 0 l)0416
6
SERVICE ADDRESS S$I L/ / �D�J�S dot
SUBDIVISIONL/LV_b
BILLINGADDRESS f,
PHONE t/ ! 4 ` 5
LOT / BLOCK
N
T a 9� �.
MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sdwage 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 NONNEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL SEC/./'�
SIG ATURE FED ID
NA .OF SPOUSE " " "`— --_ SPOUSE SOCIAL SEC.
(�' / ,
DATE RECEIVED flJ CASH CHK-4 OFFICE USE ONLY /' 't C� RECEIVED BY � i t�