HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESWATER
COMM
K SEWER RES
METER SZ.
M/F
IRR
oO
\s.,
D6� t� /
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL. •
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 1 /
TOTAL
NAME
ACCT. #
SERVICE
ES - P.O. BOX 728 FT,
MAI
SUBDIVISION_ _k A Y_Eit_d / (._C. LOT
c J 1 -BLOCK
BILLING ADD S / 1 '6 &JLA � A CJ
PHONE 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.
CUSTOMER
SIGNATURE
NAME OF SPOUSE G
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
V�o
OFFICE USE
DATE RECEIVED [ (� CASH C-HIM
RECEIVED BY10 w `-
.:
C
U
Y