HomeMy WebLinkAboutSLC Water & Sewer ApplicationATER
COMM
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SEWER
RES
METER SZ.
M/F
IRR
SECURITY DEP
SERVICE FEE
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SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
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$ f LJ
TOTAL
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME 1)4 Tlv ��AJ
ACCT.# 1�9
SERVICE
Fort Pierce, FL 34945
SUBDNISION(�*`'Ent i,oc nc- LOT / BLOCK
BILLING
�C /,�� Al1'L 9jebP/, /Z _Q%Q9,0
EMAILADDDRM- �D%M�PARRiNNO�CCED-D]RHORTON.COM
PHONE #f<�/�� ! / f�C MOVE IN/CLOSING DATE
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 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 TEIE UTiL= SERVICE
APPLMA FOR ON TEE DAY THE WATER METER OR OTHER UTILITY SERVICE COWELMON 7S INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF'VVHEN APPLICANT STARTS UTH U NG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSECJFED ID
NAME OF SPOUSE - SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH RECEIVED BY kAV