HomeMy WebLinkAboutSLC Water & Sewer ApplicationWATER
SEWER
S/R METER SZ.
I-F�.liEp ;, ST LUCIE COUNTY WATER & SEINER DISTRICT (SLCU)
A4MNEW CUSTOMER APPLICATION 54" -0 WORIP-,
COMM
RES NAME
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M/F ACCT.# J 5(
I RR
$ 9oa SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
`y�`t• 00 METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ TOTAL
SERVICE ADDRESS S D-0 f
ax
SUBDIVISION
BILLING AD
334
LOT ! J BLOCK
EMAILADDRESS:
PHONE# %D,5- F.39 (/ 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 BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLIED FOR ON. THE DAY THE WATER METEA OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL. SEC/FED ID
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED `1 `� CASH CHECK # jS3_q_1 J RECEIVED BY