HomeMy WebLinkAboutSLC Water & Sewer ApplicationATER
rrY SEWER
J METER SZ.
�r`L� '_,�;i}L-�: ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
y 7M
RES
M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 1 / i TOTAL
NAME �� C�(6AJ
ACCT. # / U U 4 — /av-.t-9
SERVICE
Fort Pierce, FL 34945
SUBDNISION�'DC 4EZ::' LOT / BLOCK
BILLING
I(c N Azxg,:Iy R v
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EMAILADDRESS:_ DMPARRINOtPQRHORTON.COM
PHONE?�� 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.
El
'APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR TEIE UMITY SERVICE
APPLIED FOR ON THE DAY THE WATER PETER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT`S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UT=IKG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE. 274;77 744779 SOCIALSEC/FEED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED ��d - CASH RECEIVED BY