HomeMy WebLinkAboutUtility Company Approval „ aI
I Lt nL ST LUClE COUNTY WATER &`SEWER DISTRICT
NEW CUSTOMER APPLICATIOtv.' Q�' - ,d°5
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GUAR•'REV., This appllcatian hereby,�re uests:and aWth,orizes`th'e Utility to render.Water and/&o §ewa' a dis `osal
services to the, remises"de`scribed above maccord nce with h` lJ 'I' ' "
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p„ a t e ti sties present or fut rate rules an
LATERAL
Y ade a .art of this con .
regulations,which li 'reference.are m p tract.Applicant.agrees to pay Utility promptly for
$• �Q�C7C� :; TOTAL, suchservices in accordance with'the established rules and regulations. .
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„ CUSTOMERS DEPOSITS ARE NON'NEGOTIABLE OR TRANSFERABLE.
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APPL•ICANT AGREES THAT APPLICANT WILL BEGIN''PAYING=BASE FACILITY CHARGES F.OR THE UTII�ITY SERV APPLIED :FOR ON THE b ` HE WATER•METER OR ^'OTHER UTII�ITY SERVICE" CONNECTION'IS' INSTALLED AT
APPLICANT'S PROPS, ;TY, GARDLESS OF'WHEN APPLICANT STARTS U'TII IZIl�IG THE METER"AND/OR,SERVICE `4"w
CUSTOMER SIGNATURE
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SOCIAL`SEC/FED ID j
NAME OF,;SPOUSE '° �'` C� Q SPOUSE
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SOCIAL
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DATE'RECEIVED "t7Z=.` ' ? i._ '' CQ-�+ ``
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ASH CHECK# R'ECEIVED BY
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