HomeMy WebLinkAboutProject Information ST'LUCIE-COUNTY UTILITIES=:'P O:BOX 728 'FT.-P,TFEYtCE;=FL 34982
NAME
ACCT .L.? �l
SERVICE ADDRESS
;. SUBDIVISION a LOT BLOCK
L:
BILLINGADDRESS � � `' °
PHONE# :- MOVE INICLOSING'DATE
This application hereby request and authanzes;the Utility to render water aid r•'sewage disposal
?3 services to the premises desciibed aba.'ve iii`accordance with the'.Utilities present ar futare rates.
i Hiles and regulations,which by;.reference are made apart of this:contract.Applicant agrees to pay
the Utility promptly for such`services%in accordance'with,the established rules and regulations:
CUSTOMERSyDEPOSIT5 ARE NONNEGOTIABLEp.ORTR//ANSFERABLE..
FED SEG/ 470 f -
ID
s
SPOUSE SOCIAL SEC:
-aA F CE USE ONLY
DATE'RECEIYED I, CASH CHK#' RECEIVED BY
RECEf'.'-J MAY Q J 7016