HomeMy WebLinkAboutSLC Water & Sewer District Applicationv ATER P MM
SEWER ✓ ROES
METER SZ. M/F
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IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ ! 9 4�O 10 TOTAL
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION
ACCT. # a9q00 d � /7c--?& 22
SERVICE ADDRESS v'
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Fort Pierce, FL 34945 (/
SUBDIVISIONiD& LOT �U BLOCK
BILLING ADDRESS �i�v �.�G��P�� �J� �1C /"E✓ ���'L1Yf� <� /
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EMAILAD%RESS: �DJM�P2AR/R�INN0(QQRH0RT0N.00M
PHONE #N� i k-/'/+ / / MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utilityto 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
ElAPPLICANT AGREES THAT APPLICANT 1VIL. BEGIN PAYING BASE FACILITY CHARGES FOR TEE.UTiL W SERVICE
APPLIM FOR ON THE DAY THE WATER.METER OR OTHER UTILITYSERVICE CONNECTIONISINSTALLED AT
APPLICAINWS PROPERTY, REGARDLESS OF WMN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSEC/FED ID
NAME.0F SPOUSE SPOUSE SOCIAL-
6( OFFICE USE ONLY
DATE•RECENED ` t�'U " ___ CASH ram' RECEIVED By�