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��rc'iF`R COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728,FT.PIERCE,FL 34982
SEWER _ RES NAME YY1 1 f
METER SZ. M/F
ACCT.# f1
t IRR ¢�
$ 1 ' y SECURITY DEP SERVICE ADDRESS �!
SERVICE FEE
SAME DAY'FEE r'•—'• ( )�-N 1
SUBDIVISION, LOT_ ! BLOCK
OVERTIME FEE
C METER INSTALL.' BILLING ADDRESS S 111.
CFC/WATER
+ FPUA CFC PHONE# / b, 'l MOVE IN/CLOSING DATE .
CFC/SEWER
GUAR.REV. This application hereby request and authorizes 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
5� � i J 0 TOTA the Utility promptly for such services in accordance with the established rules and regulations.
S. USTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
i. CUSTOMER SOCIAL SEC/
SIGNATURE FED ID
�r NAME OF SPOUSE rpt LE 6 W AN 1 D-S O 1N SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED " - CASH �� �`�-'/ RECEIVED BY
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