HomeMy WebLinkAboutSLC Water & Sewer ApplicationLUrC, L tip:
ATER
OMM
SEWER
77"RES
METER SZ.
M/F
IRR
$ � SECURITYDEP
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 _LAP—
NEW CUSTOMER APPLICATION
0-776A
ACCT. # / U U JA �— ggq
SERVICE ADDRESS SC5,
Fort Pierce, FL 34945
---SUBDIVISIQNL�"DC Jam' --- - - - -- -- —LOT S " � BLOCK �— - -
BILLING
EMAILADDR!E'SS: �DyM2PARRINOC-DRHORTON.COM
PHONE tc/'� J (ci' 7 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_
•APPLICANT AGREES THAT APPLICANT WHL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLM FOR ON THE DAY THE WATER METER- OR OTHER UTILTi'Y SERVICE CONNECTION IS INSTALLED AT
A,PP1ffCANrS PROPERTY, REGARDLESS OF'4V7IEN APPLICANT STARTS UTII VA TG THE METER AND/OR SERVICE.
CUSTOMERSIGNATURE 7cIt.CL d SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL-
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY