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V ATER OMM
SEWER ✓ RES
METER SZ. M/F
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$ SECURITY DER
SERVICE FEE
SAME -DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME �'✓�
NEW CUSTOMER APPLICATION
C C�AJ
ACCT. # / 99
SERVICE
u.0
Fort Pierce, FL 34945
SUBDIVISIOJ"W'QC LOT BLOCK'
.BILLING
EMAILAD%DRESS: DMPARRINN00a DRHORTON.COM
PHONE d�1 � J / / MOVE IN/CLOSING DATE
Aay, f-Z. �9,1) 12
This application herebyrequests and authorizes the Utilityto render water and/orsewage 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 promptly for
such services in accordance with the established rules and regulations:
CUSTOMERS: DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGR + E S TJUT APPLICANT 'WIM BEGIN imuNG BASL FACILITY CHARGES FOR THE UTILT.CY SERVICE
APPL=7 FOR ON THE DAY THE WATER METER OR OTm R wMITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WFRN APPLICANT STARTS UTR IZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 77771 SOCIAL SEC%FED ID
NAME -OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY J
DATE -RECEIVED �' -1' CASH GLiw* #&L RECEIVED BY Z W �G