HomeMy WebLinkAboutS L C UTILITIES RECEIPTWATER
COMM
ST LUCIE CO/U�NTY UTILITIES - P.O. BOX 728; Yr. P1ERCK 1'12p z
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SEWER
NAME �)C'GL/��Jt—Tu Y�ZP1Ji
METER SZ.
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SERVICE
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SECURITYDEP
FEE
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SERVICE
SAME DAY FEE
SUBDIVISIO d(j j y� CEik LS r LOT V J BLOCK
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OVERTIME FEE
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BILLINGADDRESS`�7 i L,J
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METER INSTALL.
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CFCIWATER
PHONE .# 1 Jr J�✓ J MOVE INICLOSING DATE
FPUA CFC
CFC/SEWER
This applicationhereby request and authoriies the Utility to render water and/or sewage disposal
-
.GUAR. REV
services to the premises described above in accordance with the Utilities present or future rates,
_
LATERAL
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.
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$ t U C /
TOTAL:
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER (�
-¢-i.�-,3'77360
SOCIAL SEC/ nt�
SIGNATURE -__n .�U " �"-
"-�A ;
FEDID _
NAME OF SPOUSE
SPOUSE 'SOCIAI. SEC.
OFFICE USE ONLY.
DATE RECEIVED ��'%II� CASH CHK#�M-�&)l RECEIVED BY