HomeMy WebLinkAboutSLC Water & Sewer District Applicationst. LL�;-��L
Y ATER
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SEWER
✓ FEES
. METER SZ.
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SECURITY DEF
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL"
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION
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ACCT. # / r V 0 ,
SERVICE AD
33 3o
Fort Pierce, FL 34945 (/
SUBDNISION6eeN lDf LOT ^ BLOCK
BILLING
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EMAILADDRESS:. DMI,PARRINO(C-QRHORTOMCOM
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
EjAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE. UYU= SERVICE
A>rP1110 FOR ON TM DAY THE 'WATER METER OR OTHER UTII= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WEOEN APPLICANT STARTS UTILEEING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL-
OFFICE
DATE -RECEIVED - �' CASH C USE ONLY
Me, - RECEIVED BY