HomeMy WebLinkAboutSLC UTILITIES RECEIPTI
SEWER RESI
METER Sz.
MIF
19 0
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S
S ECURITY Dfil'
SERVICE FEE'
SAME DAY FEE
OVERTIME FEE
IlETER.INSTALL.
CFCIWATER
FPUA CFC
SCANNED
BY
St , ..Lucie County
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ACCT. #I b I
SERVICE AlDbRESS
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Tl�
SUBDIVISION LOT_Ya+aBLOCKe-�c��-
'9;( )fl�L 0'-80V-e-,#
BILLING ADDRESS
PHONE# 1 �Y W T_T MOVE INICLOSING DATE
CFCISEWER
GUAR. REV. Tbisapplication hereby request and authorim the Utility to render water and/or sewage disposal
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.
0 0 TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSfERABLE
CUSTOMER
SIGNATURE,�
NAME OF SPOUSE
SOCIAL SEC/ 5-9 3 6
FED ID
SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK # 01�56,-
h.OL
RECEIVED BYJJji
t A A�l d
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