HomeMy WebLinkAboutST LUCIE COUNTY UTILITIES]� WATER I/ COMM
x SEWER RES
METER SZ. M/F
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL. '
CFC/WATER
FPUA CFC
CFC/SEWER
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LATERAL
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ST. LUCIE COUNTY UTILITIES - P.O. BOX 728. F
NAME Clb"t tj
ACCT. # (0Q0 — b0z`(13
SERVICE ADDRESS q)-
SUBDIVISION 1 ll_0j_,(s/(jJ LOT' L)
LOCK
BILLINGADDRE5S 3 UW b/) V
PHONE3�� )q 53 �O I l�/� 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 SOCIAL SEC/ /y�—n �� /_�� ly
SIGNATURE FED ID • l 5: W J
NAME .OF SPOUSE SPOUSE SOCIAL SEC.
n(W1 OFFICE USE ONLY /�%/►
DATE RECEIVED CASH / ' C (� RECEIVED BY