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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME t,-DIko- A/ ��/U,
ACCT. #/ 9- 40P — L , & �y -
SERVICE ADDRESS 3q/ / J,4_/o ,44,
Fort Pierce, FL 34945 (/
SUBDIVIS1ONf!�'D6 LOT u FLOCK
BILLING ADDRESS &1y� 00�4'tl4C- .� `10 i, r�
EMAIL ADDD:R{EEsss:1 lD�MPARRRIINNOO-DRHORTON.COM
PHONE #rt� �1 ` �+ ! 1 ✓ 6� 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.
j��J APPLICANT AGREES THAT APPLICANT WILL. BEGIN PAYING BASE FACLT ITY CHARGES FOR THE UTH TX SI�`'ICE
d APPIIEB FOR ON- THE DAY THE WATER METER OP. t3TH R UTI TY SEP.VICE CONNECTION IS INSTALLED AT
I�s! APPLIC.ANT'S PROPERTY, REGARDLESS OF WMN APPLICANT S_rARTS UIZLIZING THE METER AND/OR SERVIC .
CUSTOMER SIGNATURE T 4M,71- . L44__ 9 SOCIAL SEC/FED ID S —
NAME OF SPOUSE
SPOUSE SOCIAL-
1/ Q OFFICE USE ONLY
14
DATE•RECEIVED q" QS O - CASH Cam# Z � RECEIVED BY