HomeMy WebLinkAboutUtility Company ApprovalSEWER • ,/ RES
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-V. ST LUCIE COUNTY WATER &SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME
j Q Q
ACCT. # _
SERVICE ADDRESS, 3,304 rn.��s�eu Gi ` I r/ i
. . _ FortPierce, FL 34945.
/Q LOT BLOCK
SUBDNISION.:
BILLING ADDRESS... NP&II114c Vc
EMAILADDRESS: - /DMPARRINOCac�ORHORTON.COM
PHONEc/�� J �✓� /� MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utilityto render water and/or sewage Asposal: .
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 df.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 TEAT:APPLICANT WILL BEGIN PAYING BASE FACnJTY CEARGES FOR TEIE UTLGITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER . UTILITY. SERVICE CONNECTION I,5 INSTALLED: AT
APPLICANT'S PROPERTY, REGANDLESS OF WHEN APPLICANT STARTS UTIIMMG THE METERAND/ORSERVICE.
CUSfOMERSIGNATURE Ai": SOCIALSEC/FED ID 1X5 - =
NAIvIEaFSPOUSE �SPOUSESOCIAL
OFFICE USE ON
PATE -RECEIVED: -3, CASH RECEIVED BY .