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HomeMy WebLinkAboutSLC Water & Sewer District Applicationv SEWER METER SZ, �L L,t l (-,UL. ,.w� ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) ti "t � i1. ; NEW CUSTOMER -APPLICATION 0;..' u� MM RES M/F IRR $ (} SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTAL CFC/WATER FPUA CFC CFC/SEWER GUAR. REV. LATERAL $ f TOTAL NAME ---�/)4 K---FZ) / V ACCT.# / UU -/ U _ � 149,37 SERVICE Fort Pierce, FL 34945 (J S U B D I V I S 10 N 6Lz /©CC cry LOT BLOCK BILLING ,/ Allm <BAy, RZ -qc,�946 9 EMAILADDRESS:. �DJMPARRINO�ADRHORTON.COM PHONE � ` / MOVE IN/CLOSING DATE This application hereby requests and authorizes the Utility toyender 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 TEAT APPLICANT WILL BEGIN PAVING BASE FACILITY CHARGES FOR THE UIU= SERVICE APPLi® FOR ON THE DAY THE WATER METER OR OTFIM UTILITY SERVICE COIDINECTION IS INSTALLED AT APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE. CUSTOMER SIGNATURE Tag 77" SOCIALSEC/FEDID NAME OF SPOUSE SPOUSE SOCIAL- OFFICE USE ONLY DATE -RECEIVED tom" CASH I GfE� RECEIVED BY