HomeMy WebLinkAboutSLC - UTILITIES RECEIPT - 10-26-18•
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D METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METERINSTALL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
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LATERAL
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ST. LU,CIE COUNTY UTILITIES - P.O. BOX 728, FT. PIERCE, FL 34982
'NAME •
SERVICE ADDRESS
SUBDIVISION W�SI LOT ` " BLOCK
BILLINGADDRESS SCANNED
St Lucia county
PHONE # 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/
NATURE FED ID
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY DATE RECEIVED � �L�� l CASH •CH-K a i C RECEIVED BY '74411
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