HomeMy WebLinkAboutSLC Utilities ApplicationATER
` i
SEWER
1MM
RES
METER SZ.
M/F
O
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR, REV.
LATERAL
,ry
$ i j r/ (,l
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER -APPLICATION
ACCT. #
SERVICE ADDRESS 33V
Fort Pierce, FL 34945
SUBDNISIONe ZI S"O
BILLING
Uc'
11-fit may
EMAILAD%DRESS:. DMPAR/RIINO�} D]RHORTON.COM
PHONE #�� J �J / / �7'+ MOVE IN/CLOSING DATE
BLOCK
4Z '_q'Q9e) 9
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 promptlyfor
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 FACHATY CHARGES FOR THE UTILITY SERVICE
1 1 APPLIED FOR ON THE DAY THE WATER METER OR OTE ER UIUATY -SERVICE CONNECTION IS INSTALLED AT
1 I 'APPLICANTS PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTMIZING THE METER AND/OR SERVICE.
01 CUSTOMER SIGNATURE 7.777 � SOCIALSEC/FED ID �
NAME OF SPOUSE.
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE41ECEIVED —Lff' CASH, RECEIVED BY