HomeMy WebLinkAboutUtility Company ApprovalSEWER
METER SZ.
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✓ REs
M/F
IRR
t $ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL.
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR: REV
_ LATERAL
$ / , d io TOTAL
ST LUCIE COUNTY WATER.& SEWER DISTRICT (SLCU)
NM CUSTOMER APPLICATION
NAME L'✓��
ACCT. #
SERVICE ADDRESS
Fort Pierce, FL 34945
SUBDIVISION6?g LOT / ! BLOCK
BILLING ADDRESS 4&v . C.iG/YG - U� /" &ot !"Z- r) J)
. 1
EMAILADDRREES�S:. �DyMP2AR{RIINO�y r0RHORTON.COM
PHONE A� )J l3Jf f ? l 6X MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utilityto render water and/or sewage disposal
services to the premises described above in accordance with the:Utilities present or future rates, rules and
regulations, whlch 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 VVEM .BEGIN PAYING BASE FAG`II = CHARGES FOR THE U ff= SERVICE
APPLIED FOR ON THE DAY THE ;WATER METER OR . OTHER DTH= SERVICE CONNECTION IS INSTALLEDAT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTII,IZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE D444 774740K& SOCIALSEC/FED ID
NAME OF SPOUSE
SPOUSE.SOCIAL-
OFFICE USE ONLY
.DATE -RECEIVED �') CASH Gk fiw# . )UL— RECEIVED BY