HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESWATER COMM
SEWER RES
METER SZ. M/F
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$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ ",J TOTAL
SERVICE ADDRESS
BILLING
PHONE &O q 6 3 " 3-i
LOT JJ BLOCK
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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 Utilitypromptly-for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/
FED ID
SPOUSE SOCIAL SEC.
DATE RECEIVED [ Cd CASH OFFICE USE C 4KVYAc� RECEIVED BYWMX
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