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NAME _
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SERVICE'ADDRESS
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DATE
This application hereby request and authorises the Utility to render water and/or sewage disp
services to the premises described above in accordance with the Utilities present or future n
rules and regulations, which by reference are made a part of this contract. Applicant agrees to
the Utility promptly for such services in accordance with the established rules and regulati
_ y� CUSTOMERS DEPOSITS ARE NONNEGOTIABLE OR TRANSFERABLE,
CUSTOMERSOCIAL
SIGNATURE I`�l��y1 f+t�(� FED ID SEC/ �j/, V3� l
NAME OF SPOUSE
DATE
SPOUSE SOCIAL
I
OFFICE USE ONLY -
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St. Lucie County - PCIS
10-09-2018 03:52:01
17055/6470
RYAN HOMES
5223 OAKLAND LAKE CIR LOT 48
FORT PIERCE
FL 34951
Amount Tendered: 608.00
Amount Paid: 608.00
Change Due: 0.00
Thank You
User ID: RODRIGUEZM
RECEIVED
RECEIVED
JAN 1 1 2019
ST. Lucie County, Permitting
SCANNED
BY
St. Lucie County