HomeMy WebLinkAboutUtility Company ApprovalATER
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SEWER
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. METER SZ..
M/F
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SECURITY PEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL..
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FPUA CFC
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ST LUCIE COUNTY WATER & SEWER -DISTRICT (SLCU) .
. . NEW CUSTOMER APPLICATION
Q
NAME -
SERVICE ADDRESS_
:Fort :Pierce, FL .34945
SUBDNIS1dNCn�J-'`''�'!D LOT BLOCK
BILLING ADDRESS . 7�� L �l�� - UC AC' / YL 2 /Z XQ9U 1
EMAILADDRESS:_ DMPARRIN00DRHORTON.COM-
PHONE (&qj) ... c— MOVE IN/CLOSING DATE
Thls 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, 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 WILL -BEGIN PAMG :BASE FACH.�.TY CHARGES FOR TOMUTII�XTY SERVICE
ApPIM : FOR. ON: THE DAY THE - WATER METER OR OTHER UTHdTY SERVICE. CONNECTION IS 7NST/AIXM AT
APPIJCANT'S PROPERTY, REGARDLESS OF WEIEN APPLICANT STARTS UTII�MNG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE TJiIt CliLkilZ�.' SOCIALSEC/FED ID :
NAME OF SPOUSE:
SPOUSE SOCIAL-
OFFICfE USE ONLY
DAIS RECEIVED 3 `I�t• Z� CASH •.ERB@ i# RECEIVED BY