HomeMy WebLinkAboutUtility Company ApprovalWATER
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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SERVICE ADDRESS
Fort Pierce, FL 34945
SUBDIVISIOJ�"D� dy LOT / BLOCK -J
BILLING
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EMQILADDRESS: �DMPARRINO0-DRHORTON.COM
PHONE#11(C,A"-"f� �/�f 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 TSE U1111HY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTiC,i'I`Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILISING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY