HomeMy WebLinkAboutSLC Water & Sewer Application%V SEWER
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METER SZ.
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SECURITY DEP
SERVICE FEE
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SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR, REV.
LATERAL
$ i TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
9,0�/ioy�
,D14 11V0-7ZAJ
ACCT. # / U U 48 / ,q 3
SERVICE ADDRESS 13
izil
Fort Pierce, FL 34945
SUBDNISIONe "`"667 � LOT 1 BLOCK
BILUNG ADDRESS /�� / 0 �111Zft-- Qi�UC A� !yn !
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EMAILADDRESS:_ DMPARRINOO-DRHORTON.COM
PHONE �Q)) � ,3_ /2? I C;Z MOVE IN/CLOSING DATE
This application hereby requests and authorizes the UtIlityto render water and/orsewage disposal
services to the premises described above in accordance with the UtilMes 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
lAPPLICANT AGREES THAT APPLICANT WH L BEGIN PAYING BASE -FACILITY CHARGES FOR THE UTIIM SERVICE
* APPIM) FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE COMECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE Z21x 74A40%,B SOCIAL SEC/FED ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY DATE -RECEIVED L CASH Ik!' RECEIVED BY4�'d