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w, T LUCIE COUNTY UTILITIES P O BOX 728,FT PIERCE.YL 34982
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METERSZ
$` ' 67. .:. SECURITY DEP SERVICE'ADDRESS a� l7 C�? 1 !'
SERVICE FEE„
SAME DAYFEE
SUBDIVISION .:� j �...- LOT t BLOC
OVERTIME FEE
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METER.INSTALL ,FILLING ADDRESS
CFC/WATER .
FPUACFCPHONE.# 772 fod1...��/..� MOVEINXLOSINGDATE
CFC/SEWER
GUAR.REV. This applicat2an hereby.request and authorizes the•Uhhty to render water and/or sewage disposal
services to tlie,oir anises described above�in,accordance with.the Utilities present or future.rates;,
LATERALrules and regulations,which by;reference are made a part of this contract.Applicant.agrees to pay.,.
the Utility promptly far such,setvices,in accordance with.the established.rules and regulations
$: r TOTAL CUSTQIERS,DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE
CUSTOMER SOCIAL SEC/
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SIGNATURE /i FED ID
NAME OF SPOUSE tf ✓`c1�CfILtSPOUSE SOCIAL SEC
OF E USE ONLY
DATE RECEIVED CASH CHK# RECEIVED,BY
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