HomeMy WebLinkAboutSLC UTILITIES PAYMENTA WATER v COMM
SEWER RES
METER SZ. M/F
hq � E2R
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METERINSTALL.
1�I CFC/WATER
FPUA CFC
CFC/SEWER
GUAR: REV.
/}/) LATERAL
1 ��z V v TOTAL
OF SPOUSE
SERVICE ADDRESS
BILLING ADDRESS
PHONE # Jr W I —110 —135 /7 MOVE IN/CLOSING DATE
This application hereby request and authoriies the,Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present of future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
[he Utility. promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ 6q _ I J I ���
FED ID JJ
SPOUSE SOCIAL
DATE RECEIVED
124 �(1 U CASH OFFICE USE ONLY
RECEIVED B
JAN 0 4 ?T9
ST. Lucie County,