HomeMy WebLinkAboutSLC Water & Sewer ApplicationIT Lr tIL
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METER SZ.
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ l
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION -
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ACCT. #
SERVICE
335-d
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Fort Pierce, FL 34945
SUBDNISIOJ`'G Si,m�7 LOT -5 BLOCK
BILLING
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EMAILADDDRR!!ESs�S:. DMPARRIINN00-rD�RHORTON.COM
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PHONE #It/"��J ! / 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 WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
ApPI,M FOR ON THE DAY THE WATER METER OR OTSER UTI Xff SERVICE CONNEMON IS "INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WREN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE TIM7 Cti 77,7 SOCIALSEC/FED ID rT
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH RECEIVED BY