HomeMy WebLinkAboutSLC Water & Sewer ApplicationY SEWER
/YJ METER SZ.
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SERVICE FEE
SAME DAY FEE
OVERTIME FEE
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION
SERVICE ADDRESS .3
.-- 7 L5
Fort Pierce, FL 34945
SUBDIVISION6e-&-25tS"6C 4Z'
BILLING
VIC
LOT 3 7
Alin 'gv�p
EMAILADDRESS: DMPAR/RIINN00-C)RHORTON.COM
PHONE I� )) ! 7 �c�, MOVE IN/CLOSING DATE
BLOCK
13Q9,9 /
This application hereby requests and authorizes the Utilityto render water and/orsewage 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 promptlyfor
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 UMITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTlL.IZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE Z244 b Qn4Z.-te SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED q-00 0;20 CASH CFIEC*O—" C. RECEIVED BY