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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
SERVICE ADDRESS 3
Fort Pierce, FL.34945
SUBDNISIOJee' D� 4 LOT i BLOCK .
BILLING ADDRESS
1
EMAILADDRESS:DMPARRINO@DRHORTON.COM
PHONE lep �// MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utillty:to r rendewater 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 promptlyfor
such services in. accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR -TRANSFERABLE.
-APPLICANT AGREES TErr1T APPLICANT WJU BEGIN. PAYING BASE Ii'AMM CHARGES FOR 3M UMM SERVICE -
APPLM FOR ON TIM DAY THE _WATER NI OR OMRTII,iLTY USMVICE: COI�TECTiON IS: INSTALLED.: AT
APPLICANT'S PROPERTY, REGARDLESS OF 'WHEN APPLICANT STARTS UTIMTZING THC METER AND/OR SERVICE:
CUSTOMER SIGNATURE.. SOCIAL SECIFED ID ..
NAME OF SPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED `�4•� CASH 6�Imm" RECEIVED BY
�.