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SAME DAY FEE
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME^'
NEW CUSTOMER APPLICATION
.1010 4r
ACCT. # I8 �0 --- �/
SERVICE ADDRESS
Fort Pierce, FL 34945
SUBDIVIS10NC?J '`'''�'lDt LOT / /l/ BLOCK
BILLING
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EMAILADDREss:- DyMPARR1NOCcD_D�RHORTON.COM
PHONE ��) J �(193— I' I MOVE )N/CLOSING DATE
This application. hereby requests and authorizes the Utiiityto 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 THE UTIIJT`Y SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSECTFED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY
C