HomeMy WebLinkAboutSLC Water & Sewer District ApplicationTER
N/ SEWER
METER SZ.
L4-C(jE ST LUCI€ COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
MM
RES
M/F
1RR
$ Cam' O
SECURITY DEP
i SERVICE FEE
SAME DAY FEE
OVERTIME FEE
-METER INSTAL
CFC/WATER
-FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 7 TOTAL
ACCT. # ag 40'�— 1 �%%
SERVICE ADDRESS 33.E
Fort Pierce, F.L�34" 945
SUBDIVISIOjeez°''_''�LOT �z BLOCK
BILLING ADDRESS 49l.�-G"XA_'!?1 f ` '•-
EMAILADDRESS: �DMPARR] NO DRHORTON:COM
PHONE #lf�3Q)) ` f MOVE IN/CLOSING DATE
This application hereby requests and -authorizes the Utilityto render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates, rules and
regulations, which by reference are made A part of this contract. Applicant agrees to.pay Utility promptly for
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE,
APPLICANT- AGREES THAT APPLICAN.E WML BiGIN PAYING BASF FACILIT 7. CHARGES FOR THE UMXIY SMVICE
j APPLM FOR � ON 'I ^ � DAY THE" WATER lbw x"iGR OR OZ�:� 17TFd�.' SM`4ICE CONNIECTIQN IS INSTALLED AT
AppljCANI"S"PROPERTY, REGARDLESS OF T APPLICANT STARTS IJi`MVJNG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE D�iZCL. Ltit�ti�t9 . SOCIAL SEC/FEED ID ?S—
NAME OF SPOUSE SPOUSE SOCIAL
OFFICE USE ONLY
DATE -RECEIVED AL CASH ®� C_ RECEIVED BY w