HomeMy WebLinkAboutST LUCIE COUNTY UTILITIESWATER
COMM
SEWER
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE.
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FPUA CFC
CFC/SEWER
GUAR. REV..
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SERVICE ADDRESS" u/ Cal/
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BILLING ADDRESS_ _ I f`T I L , T W L14( - At
PHONE # MOVE IN/CLOSING DATE.
This application hereby request and autho_riies 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.
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CUSTOMER %)
SIGNATURE
NAME OF SPOUSE
sbciAL FED ID SEC/ � j 1 3/ V D O U
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHK# -/ )RECEIVED BY