HomeMy WebLinkAboutUtility Company Approvall (1E Yam. ST LUCIE COUNTY WATER'& SEWER DISTRICT (SLCU) .
NEW CUSTOMER APPLICATION
ATER: - MM
IN SEER R
METER SZ. MJF
• � IRR
$ �7 )JSECURITY DEP
SERVICE FEE'
SAME: DAY FEE
OVERTIME FEE
METER INSTAL
cFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
NAME
11 070A
ACCT. #
SERVICE ADDRESS
FortMerce, FL:34945
SUBDNISIOJeezt` be JJr— LOT BLOCK
n
BILLING ADDRESS L)lo—q �Y eiilc- A'&)n
EMAIL ADDRESS: DMPARRINO ODRHORTON.COM
Pa-���
HONE_ MOVE INJCLOSING DATE
This application hereby requests and authorizes the Utility.to renderwater and/or sewage'disposal
servicesoto 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.
APPLICANT AGREES TEAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR 1� UTHXIT SERVICE
APPLIED: FOR ON TiIIE DAY- THC WATER METER OR: OTHER .UTMITY 'SERVICECONNECITON ISINSTALLED AT
APPLYCANrS PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UT THE METER AND10R SERPiCE.
CUSTOMER SIGNATURE SOCIALSECjFED ID
NAME OF SPOUSE SPOUSESOCIAL-
n OFFICE'USE ONLY
DATE -RECEIVED, =IR`oZ� CASH ccLiEEIE# RECEIVED BY