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COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX 728'FT.PIERCE FL 34982
SEWER V RES NAME �I G! ��
METER SZ. M/F
ACCT:,#,:-.:.;;
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SECURITY DEP SERVICE ADDRESS' �v yi2e
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SERVICE FEE
SAME DAY.FEE
! SUBDIVISION' ='. LOT: BLOCK
OVERTIME FEE
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METER INSTALL
BILLING ADDRESS 4vV61
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CFC/WATER
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PHONE IN/CLOSING DATE
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.
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S TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
�. CUSTOMER SOCIAL SP-C/, �, r f i9
SIGNATURE_ 1 "r FED';ID" CEJ I
NAME OF SPOUSE O C� �LC SPOUSE SOCIAL SEC. a LD�
.OFFICE USE ONLY
f DATE RECEIVED t �. CASH CHK# �� RECEIVED B