HomeMy WebLinkAboutUtility Company ApprovalATER OMM
SEWER ✓ RES
S METER SZ. M/F
IRR
$�� SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
.METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ a TOTAL
Mv.
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ST LUCIE COUNTY WATER& SEWER DISTRICT (SLCU).
NEW CUSTOMER APPLICATION
NAME AV gw-z/j
ACCT. #1a8g -- �a1
SERVICE ADDRESS i 401 Pou ai Le, To\i
Fort Pierce, FL 34945
SUBDNISION�i®&7 j LOT IO BLOCK
BI W NG ADDRESS /l/f., Uc !�i . JcQ90 /
EMAILADDRESS:. DMPARRINO ar DRHORTON.COW _
PHONE ��)) ( �f / O� MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility:to renderwater 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 AGREES THAT APPLICANT WILL -BEGIN PAYING BASE FAC MY CHARGES FOR TEIEUTII I Y SERVICE
I I APPIIM FOR ON ZEIM DAY TEE WATER METER OR OTM R UTiiffY SERVICE COMEMON 10 INSTALLED AT
LL. rrJJ APPLICANTWS PROPERTY, REGARDLESS OF WDEN APPLICANT STARTS UTJI 2M4G THE METER. AND/OR SERVICE,
CUSTOMER SIGNATURE DaSOCIAL SEC/
� FED ID IS-51
NAME OF SPOUSE
SPOUSE SOCIAL-
, r OFFICE.USE ONLY
DATE -RECEIVED- 3t1 vn 1'c�-t CASH _. . RECEIVED BY
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