HomeMy WebLinkAboutSLC Utilities ApplicationU SEWER
5 METER Sz.
T" � Q1L.
MM
RES
M/F
.a IRR
$ 06
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
�y LATERAL
$ 1 / s TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME J/ P— 11,00-77W
ACCT. # ! U I —AU — /a of
SERVICE ADDRESS 3c�? ! � � /- � 'ez—
Fort Pierce, FL 34945
SUBDIVISION�'Q67 4Z�C7 LOT T BLOCK
BILLING
EMAILADDRESS:. DMPARRIIN�J00-DRHORTON.COM
PHONE 4A%%�)) VJ' // / / .;Z MOVE IN/CLOSING DATE
q 13Q9Q %
This application hereby requests and authorizes the Utilityto render water and/orsewage 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 THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTHXTY SERVICE
El
APPLIED FOR ON TM DAY THE WATER METER OR OTHER UTII.ITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF'WHEN APPLICANT STARTS UTffXEI TG THE METER ANDIOR SERVICE.
CUSTOMER SIGNATURE = CLtil. " SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY RECEIVED BY �A d
DATE -RECEIVED