HomeMy WebLinkAboutST LUCIE UTILITIESWATER COMM
�( SEWER RES
LJ METER SZ
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.'
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
NAME
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)VE 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 50CIAL SEC/ %J�n
SIGNATURE FED ID
NAME .OF SPOUSE r �-C � /% SPOUSE SOCIAL SEC.
N� l� OFFICE USE ONLY
RECEIVED
DATE RECo� CASH - RECEIVED By"�
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