HomeMy WebLinkAboutUtility Company Approval -- - - — - ELL'1-" �•. -ST LUCIE—COUNTY WATER_&_SEINER DISTRICT
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NEW CUSTOMER APPLICATION
A7ER yOiVtM
SEWER — RES NAME-
METER SZ. M/F ACCT.#
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$ SECURITY DEP !>�-1
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SERVICE ADDRESS D� � 7Z C�(z-
SERVICE FEE Fort Pierce, FL 34945
SAME DAY FEE SUBDNIS,ojt, '`C-'/,6C LOT / BLOCK
OVERTIME FEE
METER INSTAL
BILLING ADDRESS y IZW-- �U� / 6
CFC/WATER EMAILADDREss: DMPARRINOCa_DRHORTON.COM
FPUA CFC PHONE 4C%- 73,3—9?202 MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. 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
LATERAL regulations,which by reference are made a part of this contract.Applicant agrees to pay Utility promptlyfor
4 $ /Wf TOTAL such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WML BEGIN PAYING BASE FACILITY CHARGES FOR TBE UMITY SERVICE
APPL= )�'OR ON THE DAY THE WATER METER OR OTTaERR UTILITY SERVICE CONNECTION ZS-ANSTALLED AT
APPLICANT'S PROPERTY,REGARDLESS OF WHEN APPLICANT STARTS UTILIZING TEIR METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID —
NAME OF SPOUSE SPOUSE SOCIAL•
OFFICE USE ONLY de,
DATE RECEIVED CASH RECEIVED BY