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�..,- �,,�.�^a � COMM ST LUCIECOUNTYUTILITIES PO BOX728,•ET PIERCE,FL 34982.:
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'�CURITY DEP''t„ SERVICE ADDRESS' ���'� S S'�
_ RVICE FEE �0
K r r
AME DAY FEE ,
s � r SUBbIVISION rv�'/R�ti f'/L���57` ;LOT := BLOCK _ !
VERTIME FEE F f
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ETER INSTALL: s
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zcAVATER
'UA CFC ,
PHONE# ! MOVE IN/CLOSING DATE
tC/SEWER
This apphcahon hereby request and authonzes 4he Utthty to render water and/or:sewage.'d�sposai':
t� REV services torthe premises described above in accordan&e`im th the Uhlrties present or future rates,`
RAL= rules and regulations,which by reference are made a part of thiscontracf:Applicant agrees.to pay
the Ut�hty promptly for such serv�cesm acpordance with the,estabhshgd rules°and regulations
TAL CUSTOMERS DEPOSITS ARE NON NEGOTLABLE OR TRANSFERABLE
JSTOMER ,SOCIAL SEC/ 1
;NATURE FED`ID�
ly
ME OF SI'OUSE:' � D �/�J �7 ! ���/�f'j'}� SPOUSE SOCIAL SEC-
OFFICE USE ONLY'
DATE RECEIVED' CASH C�-O RECEIVED BY�_ j
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