HomeMy WebLinkAboutUtility Company ApprovalTER
y SEWER
METER Sz.
Om
✓ RES
M/F
1RR
$ D
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 11 f TOTAL
ST LUCIE COUNTY WATER & SEWER.D[STRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME
fLt`0AJ
DO
ACCT. # U
SERVICE
Fort Pierce, FL 34945
SUBDNISION/D JJ-� LOT BLOCK
B NG ADDRESS & L�`���- ��Uc ! _ c &X4.4-k , ILLI _�� � �
EMAILADDDRREEss: DMPARR1N0
�}_DRH0RT0N.00M
PHONE #c.J �~ /� / 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, 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.
j�'''� APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UT=Y SERVICE
{ j APPLYED FOR ON THE DAY THE . WATER METER OR OTEER UTHffY SERVICE CONNECTION IS 'INSTALLED AT
�. APPLICANT'S PROPERTY, REGARDLESS OF NVEMN APPLICANT STARTS UTILUMGTHL METER ANDIOR. SERVICE.
CUSTOMER SIGNATURE ��itCL 50CIALSEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE -USE ONLY
DATE -RECEIVED CASH eNfer# � RECEIVED BY