HomeMy WebLinkAboutSLC Water & Sewer ApplicationSEWER
METER SZ.
M
M
RE
M/F
IRR
s
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL t BILLING
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ / TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME —JP—
NEW CUSTOMER APPLICATION
i2(—OA'
ACCT. ## / 90,90 " / lJ r~ / ,?63
SERVICE ADDRESS.
333.3 (
Fort Pierce, FL 34945
SUBDIVISION6eE-d f 0C � LOT 19 BLOCK'
,vc /)� &It,gAy, ) q 9") /)
EMAILADDDRESS: fDMPARRINOO-DRHORTON.COM
PHONE `� l / / 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.
aAPPLICANT AGREES THAT APPLICANT wnL BEGIN PAYING EASE FACILITY CHARGES FOR THE UT Xry SERVICE
APPIIF.D FOR ON THE DAY THE WATER METER OR OTHER 1T =Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED ' � X l CASH 64peK ##' , c-, RECEIVED BY �.��1