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City of Port St Lucie Utility Systems
121 SW Port St. Lucie Blvd
Port St. Lucie, FL 34984
(772)871-5330
Utllitya cityofpsl.com
1227I2019 0 RECEIPT#10362591
Customer- Account: 1047153 - 816192
CHAD HINKLE
7405 SILVER OAK DRIVE
Deposit Paid- Water $ 50.00
Miscellaneous $2,753.00
Subtotal $2.803.00
Total $2,803.00
TENDERED
Check N509. $2.753.00
Check #5'10 $50.00
Total $2.803.06
Change $0.00
Remaining Balance-$2,803.00
Cvcle: 01 Book: 008
Zone: NON/PD
Plant: WP
CITY OF PORT ST. LUCIE UTILITY SYSTEMS DEPARTMENT
NEW RESIDENTIAL SERVICE APPLICATION
1047153 - 816192
Customer - Account
WATER Capacity: (One ERC):
NON SAD/USA Line Fee:
E SAD/USA''/" Meter Fee:
NON SAD/USA''%" Meter Fee:
34952 TOTAL WATER,
PORT ST LUCIE FL 34952 SEWER Capacity: (One ERC):
NON SAD/USA Line Fee:
Grinder Installation:
LPS Installation Fee:
Septic Service:
Gravity Sewer:
TOTAL SEWER:
Security Deposit Water:
Security Deposit Sewer:
23 Recording Fee:
$ 1,401.00
$ 722.00
$ 630.00
$ 2753.00
LESS LESS DEPOSIT & RECORDING $
TOTALAMOUNTDUE: $ 2803.00
❑Cash ❑ CreditCard WjCheck # 509,510
RECEIPT #: 036591 i DATE PAID: 12/27/2019 BY: SSASSER
UTILITY will provide water and/or sewer service upon payment of the applicable connection charges and compliance with the Terms and Conditions listedon the back of this service Application. The Utility policies provide for a water
and /or wastewater plant capacity allocation of two hundred and fifty (250) gallons per day equivalent residential connection (ERC). The Utilitywill not be obligated to provide capacity of service in excess of the allocation and may
require consumerto curtall use which exceeds such allocated capacity. I have read and acknowledge receipt of this Service Agreement by signature below.
l C /r'r 7/i
A
Customer Signature
Date