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APR 2 7 2016
PERMITTING
St. Lu,-,ie County, FL
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ST NCIE:COUNTY UTILITIES P O.BOX 728 FT PIERCE .FL 34982
f NAME
it V11,
Lucie Cowl :40 I2
27-2016 0
RVEY17TYLERI ! SERVICE ADDRESS
4 BRADLEY ST
SRT PIERCE
.. 34982
count Tendered: 600.00 [ SUBDIVISION LOT. BLOCK
I �
Daunt Paid' 519.00 { BII LINGADDRESS
ianse Due: 81 .00
Hank You '7"7 � ,j�j � ,��_�� _
PHONE# MOVE IN/CLOSING DATE
ser ID; WARDD
This apphcat!on hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises descnbed above in accordance with.the Utilthes present or future rates,
rules and re ulahons,whicl%b reference are made agpart of this contract A hcant a `reqs to `a
LATERAL g Y PP; g., P.Y
,Uhhty promptly for such services m accordance with the established rules and regulations
CUSTOMERS DEPOSITS ARE NQNNEGOTIABLE ORTRANSFERABLE:
CUSTOMER SOCIAL SEC
SIGNATURE FED ID
NAME QF:SPOUSE SPOUSE SOCIAL SEC
r7
jE USE ONLY
DATE RECEIi/ED •r !�. CASH CHK#. RECEIVED B !/