HomeMy WebLinkAboutSLC Utility ApplicationTER
SEWER
f !� METER SZ.
TG
MM
M/F
IRR
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( SECURITY DEP
I SERVICE FEE
SAME DAY FEE
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION
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ACCT. # IU U F 0
SERVICE A
Fort Pierce, FL 34945
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SUBDIVISION��D� LOT BLOCK
OVERTIME FEE
IVIETER INSTAL BILLING
CFC/WATER
FPUA CFC
CFC/SEWER
uc Ac A��a�fl, ) 29012
EMAILADDRESS:DMPARRiN0 flQRHORTON.COU
PHONE #A% )) _.-MOVE IN/CLOSING DAIS
GUAR REV. This. application hereby requests and authorizes.the.Utility to renderwaterand/orsewage disposal
services to the premises described above in accordance vnth the Utilities present or future rates, rules and
LATERAL regulations, which by reference are made a part of this contract. Applicant agrees to pay Utility promptlyfor
f LJ TOTAL such senrices in accordance with the established rules and regulations.
'CUS"TOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BABE FACMITY CIRARGES FOR THE. UIU TY SERVICE
APPa iED FOR ON = DAY THE WATT WTER OR OTMR UI7LTTY SERVICE CONNEC110N IS INSTALLED AT
A.PPLI[CANT'S PROPERTY, REGARDLESS OF WHEN APPLIC'Al\'T. STARTS iT'iILi7A'aTG. THE METER A�TD/®R SERVICE.
CUSTOMER SIGNATURE iAe" SOCIAL SEC/FED ID'
NAME OF SPOUSE - _ SPOUSE SOCIAL -
OFFICE USE ONLY ��f /�
DATERECENED `" !9- CASH Cam# / yi cf RECEIVED BY /�Lfd