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HomeMy WebLinkAboutSLC Water & Sewer ApplicationSEINER METER SZ. LUG U, L �y � fir•. ��MM L/ RES M/F IRR SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTAL CFC/WATER FPUA CFC CFC/SEWER GUAR. REV. LATERAL $ / r TOTAL ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION ACCT. # 1 ! U U I/U SERVICE ADDRESS Fort Pierce, FL 34945 SUBDIVISION�i©c JJ� LOT BLOCK BILLING ,,vc- /ic, &Ngv�v EMAILADD::R{{ESS:�DM�PARRINO DRHORTON.COM PHONE ES�) f#fib 3_ 9'9 / C;Z MOVE IN/CLOSING DATE q JIQgd 9 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 FACII,I'I'Y CHARGES FOR THE UTHIITY SERVICE El APPIM FOR ON THE DAY THE WATER MET M OR OTHER •OTILLTY SERVICE CONNECTION IS INSTALLED AT APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE NIXTER ANDIOR SERVICE. CUSTOM ERSIGNATURE SOCIALSECIFED ID — NAME OF SPOUSE SPOUSE SOCIAL - OFFICE USE ONLY gci_ DATE-RECEIVED / i - CASH �616# RECEIVED BY