HomeMy WebLinkAboutSLC Utility ApplicationATER
�MM
SEWER
t/ RES
METER SZ.
M/F
1RR
$� SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV..
�j LATERAL
$ / r jO TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION
D/ 4 1149a-r-OAJ
ACCT. # / (1 U V `'— ! a & /
SERVICE
Fort Pierce, FL 34945 (/
SUBDIVISIONe Z+`Y"0 42�C7 LOT &�_ BLOCK
BILLING
itC /,Jc 'aggz)
/)
EMAILADDRRESS: fDJM�PARRINO@DRHORTON.COM
PHONE dC5ES) tcJMOVE IN/CLOSING DATE
This application hereby requests and authorizes the Util ty 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 WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UIU= SERVICE
j APPLIED FOR ON THE DAY THE WATER METER OR OTHER U UM SERVICE CONNECTION IS INSTALLED AT
L--) APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE Z7,4 L Q/t/LGlZ�9 SOCIAL SEC/FED ID rI
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE RECEIVED CASH tom# RECEIVED BY (/U