HomeMy WebLinkAboutSLC Water & Sewer Applicationi
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ATER
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SEWER
1��MM
RES
Z78—M ETER SZ.
M/F
IRR
$i1 0
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR, REV.
LATERAL
$ f TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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ACCT. # / U UyU __ V cia
SERVICE
23/L/
Fort Pierce, FL 34945 l/
SUBDIVISIOJea- i,oc LOT L/ BLOCK
BILLING ADDRESS 11CJ� (.i-G/�-y /"�
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EMAILADDRR!Esss:, QM�PARRINOODRHORTON.COM
PHONE T 3— / MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to 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 WRL BEGIN PAYING BASE FACILITY CHARGES FOR TEIE UTILITY SERVICE
1 i APPIM) FOR ON THE DAY THE WATER METER OR OTHER UTILITY ;SERVICE CONNECTION IS INSTALLED AT
--1 APPLICANT'S PROPERTY, REGARDLESS OF WIEEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE �GftC'i GZistiB SOCIALSEC/FED ID
NAME OF SPOUSE
DATE RECEIVED CASH
SPOUSE SOCIAL
OFFICE USE ONLY
RECEIVED BY