HomeMy WebLinkAboutSLC Utilities ApplicationATER �OMM
VSEWER RES
METER SZ. M/F
'�`-- IRR
$'
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER .
i
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ j d e� TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
r Fr.
NAME 0tp
NEW CUSTOMER -APPLICATION
957-0A
ACCT. # / U 40— /41�
SERVICE
3&tQ5 �l
Fort -Pierce, FL 34945 U
SUBDNISIONC%�`DC 41_ LOT ! BLOCK
BILLING
EMAILAD%DRESS:-1 DMPAR/RIINO�@DRHORTON.COM
PHONE #11�J (cJ�j /� / MOVE IN/CLOSING. DATE
This application hereby requests and authorizes -the -Utility to renderwater and/or sewage disposal
services to the premises described abode 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, UTIIIIY SERVICE
APPIJED FOR ON THE DAY THE RATER NIX MR OR OTHER UTII= SERVICE CONNECTION . IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF'WEIEN APPLICANT STARTS UTMI ZING TEE METER AND/OR SERVICE,
CUSTOMER SIGNATURE z2z;f� &4MA49 SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE. USE ONLY - DATE -RECEIVED CASHEfti<CK# �1��
q -�' �� RECEIVED BY f!�Xr(J( Zk.