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WATER, 'COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728 FT.PIERCE FL 34982
j SEWER RES A// A
NI -- METER SZ. M/F
5000 \* ACCT.#,
FOR1 IRR
FL
$ � �J r.� i1 SECURITY DEPSERU�CE�pDRES : L. ''
AmOU SERVICE FEE
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SAME DAY FEE
Amoul SUBDIVISION L"OT:' B'LOCK`" x
OVERTIME FEE.
Chane (�V METER INSTALL BTLTsING AbDRESS' ''�
Than CFC/WATER
r -
FPUA CFC a J�l
Jf J-_C�'��- �_ . -MOVE-IN/CLOSING.DATE
Us81"i CFC/SEWER
This application hereby request and authorizes the Utility to render water and/or sewage disposal
- GUAR.-REV. `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 Utility promptly for such services in accordance with the established rules and regulations.
s �- t/ TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SIGNATURE`. FED.•ID ✓' �/ `7` /;� G/
j NAME OF SPOUSE SPOUSE SOCIAL SEC.
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OFFICE USE ONLY
I DATE RECEIVED�� CASH BY l
, 74 /