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X. WATER � / COMM' ST..LUCIE
4
SECURITY DEP ~ SERVICE
SERVICE FEE
17
j SAME DAY FEE '" s
• r r >SUBDIVIS
�I OVERTIME FEE ' � ; '
I s BELLING
METER INSTALL F i
CFC/WATER
W CFC
PHONE —77
CFC/SEWER
GUAR REV This;:apph
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', rLATERAL ruleS,and II
the`Utility
CUSTOMER
SIGNATURE ` , • ����_. � '
NAME, .0i SPOUSE,:-
Of
_ DATEREGEIVED.=
fY UT ITIES P O BOX 728 rFT PIERCE yFL 34982 : r
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LOT :E BLOCK
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MOVE IN/CLOSING DATE -
reby request and authorizes the Uhhty to render water and/or sewage disposal
miles described above �n accordance with the Uttlittesrpr`esent or future rates,
ns which by refere,`nce'aref Madera part of this�contract Applicant agrees to pay
lyforrsuctr, services maccordancewithfthe esfabhslied rules aad regulattons
PQSITS AREyN,ON�NEGOTIABLE OR TRANSFERABL>E " .'.t ,
SOCIAi SEC/f
'FED,ID z fr '
SI'O At SOGIAL SEC:
'EVOY
JSE ONLY �^
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