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ST LUCIE COUNTY UTILTTIES P O BOX 728,FT PIERCE':FL 34482
County - PCIS I
I5 08:32:32
1/4554
MICHAEL SER�/ICE AbDRESS /D • �riit'/U�
d DR
ICE 'of
�., ..-,
andered: 518.00
SUBDIVISION `�' LOT BLOCK :
aid 518.00
BILLING.,
ae: 0.00
WARDD MOVE IN/CLOSING DATE`.
j
This application hereby request andauthor>zes the Utilityto render water andLor sewage disposal
> - sevices tathe premises descnbed above in.accordance with the Utilities present or future rates,
LATERAL rales and regulations,w kir'y reference are;made apart of flus contract Applicant agrees to pay
the Utihtypromptly for such services m accordance with the established rules and regulations to
TOTAL
,.; CUSTOMERS DEPOSITSARE NON NEGOTIABLE OR TRANSFERABLE
MER SOCIAS
i. EG
'URE '.
.; FED ID
OF;SPOUSE SPOUSE..SOCIAL SEC
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED BY