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1:
-iAM ST.LUCIE COUNTY UTILITIES-iP.O.BOX 728 FT.PIERCE FL 34982
SEWER RES NAME-
METER SZ., MIF
ACCT.# t
SECURITY DEP SERVICE,ADDRESS �9 j 3
SERVICE FEET -
1
SAME DAY FEE
SUBDIVISION LOT BLOCK
OVERTIME FEE
BILLINGADDRESS am C`YAP
METER INSTALL.
CFC/WATER �j^ J��j ['
FPUA CFC
PHONEM/7 1 I"1�` 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-
the
aythe Utility promptly for such services in accordance with the established rules and regulations.
It TOTAL USTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER SOCIAL FED DSEC/
SIGNATURE
NAME OF SPOUSEi ` SPOUSE SOCIAL SEC.
(f f FF USE'ONLY
TI ATT:.D r70VTxT1:T t /t/�.i ♦nrT .,...� ..