HomeMy WebLinkAboutSLC Utilities ReceiptLU!:CIC ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
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NEW CUSTOMER APPLICATION
_ WATER COMM
�L SEWER RES
METER SZ. M/F
IRR
oa
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
/�22 jj // OVERTIME FEE
4134. D`,� -METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ i bO TOTAL
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ACCT_ # ! 59(4,-,1 ^-~
SERVICE ADDRESS 54 S71
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SUBDIVISION �/�•tp.��� SL
BILLING
1
3
it
LOT - BLOCK
EMAIL ADDRESS: "
PHONE## . 5" F-3 9 L/ 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 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 SASE FACILITY CHARGES FOR THE UTQ,X'i'y SERVICE
APPLM) FOR ON THE DAB' THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF W. + N APPLICANT STARTS UTILIZING ME METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
OFFICE USE ONLY
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DATE RECEIVED_ �- �, CASH CHECK # j 573 C1 Q T RECEIVED BYI��J .