HomeMy WebLinkAboutMisc Letters fl G fJ1,
lv
•�> .�� `' I I I I ; �I illi• .. i � , '
., , 1'?,p!G•,7.r"� r '�t!s'%7�Rn tt. tj,�rr--rT'�. carc
.,I t '1
•? r.j'i ` 4 r„ `y;.: `�� �� r � h t ` 1111 I I ," I �t t II I > s +,
F
COMM '.','I ST LUCIt:COUNTY UTILIT ES,:-',P O.BOX1728 FTP .RCE 'FL 34982
"YE
RES NAMEI IC.L . It I f`V�bk
`, ter' METER SZ M/F
ACCT
jf� � � � IRR I I ;� � • •;' � '' I i.�,i I . ' • I I ` I ;
$ O SEC TY DEP` SERVICE ADDRESS �� '' � �
SERVICE FEE -
I
S' E DAY FEE I I i 1 I I IF C
SUBDIVISION BLOCIQ!
y� OV RTIME FEE
(VJ/
ME ER INSTALL
BILLINGADDRESS �8f ; ,1 . ��r�-E��:r
} + , •, ( ill i I I is T
'CF /WATER
I.
FP CFC 77a- 3�/ �-/ D 11 I I,
PHONE MOVE IN/ LOSING DATE
CF /SEWER.
GUAR.REV. This application hereby request and authorizes the Utility to ender water and/or sewage disposal
i. services to the premises described above in accordance with the Utilities present or future.rates
LATERAL rules and regulations;which by r'Terence are,made"a part of t is contract,.Applicant agrees to pay
the Utility promptly for such services in accordance with tl�e established rules and regulations.
$ �` TOTAL
I CUSTOMERS I DEPOSITS BARE(NON NEGOTIABLE OR T{tANSF$RABLE:
CUSTOMER ; SOCIAL SEC/
7
J '
SIGNATURE /j� -�C . '?d pus J�'.y' FED:ID �I i .
SPOUSE SOCIAL SEC
NAME OF SPOUSE f`Ut11C S
�Jt Q- r-�, --
OFFICE O . Y (' .�� , .
i
DATE RECEIVED CASH: CHK ) RECEIVED BY