HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESk
WATER
COMM
SEWER
(�
RES
METER SZ.
M/F
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
a AL
OVERTIME FEE
METER INSTALL.
CFC/WATER
tk
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
DATE RECEIVED
RECEIVED MAR 2 9Z013
NAME
ACCT. #
SERVICE ADDRESS
v
SUBDIVISION % �, -LOT_ J 3 BLOCK
BILLING ADDRESS
ONE # MOVE IN/CLOSING 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.
SOCIAL SEC/ 0 3 f 3 �� ��
FED ID(o
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
CHK #
RECEIVED