HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESWATER COMM
SEWER RES
METER SZ. M/F
9 6a IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
l LATERAL
$ J TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
ACCT. # `
SERVICE ADDRESS
U
SUBDMSION 1 1
BILLING ADDRESS / _ C
._BLOCK
PHONE t(4A / `�3 �:2 w U 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 fog such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
DATE RECEIVED ti o� O CASH OFFICE USEONLY �,, CEIVED BY