HomeMy WebLinkAboutSLC Water & Sewer District Application� �,�• •• � Syr
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4 ATER MM
SEWER ` �RES
METER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV,
LATERAL
$ ! TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME��^'
SERVICE
NEW CUSTOMER•APPLICATION
a7-0A
33.tla
Fort Pierce, FL 34945
SUBDNISIONe G`S'b&7 � LOT BLOCK
BILLING
vc /J6
EMAILADDDRREESnSS: DMPAR/RIINO�} DRHORTON.COM
PHONE #lic/ �J / / 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 APPLICANT WILT. BEGIN PAYING BASE FACRM CHARGES FOR THE UTJLITY SERVICE
El
APPLIED FOR ON THE DAY TIE WATER METER OR OTHER TTIUXI Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE % "Zd- d�ritistd SOCIALSEC/FED ID '1
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED_ ` � 0 " 210 CASH E� RECEIVED BY