HomeMy WebLinkAboutSLC Utility Application�••'� TWA �tir
L
ATER I
SEWER RES
METER SZ. M/F
IRR
$ 90
9—SECURITY DEP
—� SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
j.} LATERAL
$�i f /1 TOTAL
i�
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME /k- FIB' a7
ACCT. # %Si
A
SERVICE
Fort Pierce, FL 34945 C/
SUBDNISIOJ�"067 - 42�C7 LOT ! BLOCK
BI W NG ADDRESS _ (-G/_Il�h/ "� �m 9,01)
EMAILADDRESS:. F`DMPARRINO(ZORHORTON.COM
PHONE #�%�) l {,5,3_ 97 f , 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.
APPLICANT AGREES THAT APPLICANT WIDL BEGIN PAYING BASE FACILITY CHARGES FOR" THE UTILITY SERVICE
4PPL11E'D FOR ON THE DAY THE -WATM METER OR OTHER UT[IdTY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS O]P WHEN APPLICANT STARTS UTIEffING TIDE METER AND/OR SERVICE.
CUSTOMER SIGNATURE =M,,9, dAA SOCIALSEC/FED ID r1
NAME OF SPOUSE
SPOUSE SOCIAL-
OFFICE USE ONLY
DATE RECENED �1 _ CASH CHE£-K#f �� RECEIVED BY d6
h.