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4U.CE. ST LUCIE COUNTY WATER&SEWER DISTRICT(SLCU)
NEW CUSTOMER APPLICATION
ATER _ MM
71-
SEWER RES NAME L/� F!Z'��/�'/
>. S METER SZ. M/F ACCT.#
IRR _
$ SECURfY DEP SERVICE ADDRESS V
SERVICE FEE Fort Pierce, FL 34945
SAME DAY FEE SUBDNISION[r+"� BLOCK
OVERTIME FEE
BILLING ADDRESS
METER INSTAL
CFC/WATER EMAILADDREESS: DMPARRINO _DCa� RHORTON.COM
FPUACFC PHONEdI )J -3f I q2c _ -_ MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. Thlsanplication hereby requests and authorizes the Utilftyto render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,rules and
LATERAL regulations,which by reference are made a part of this contract.Applicant agrees to pay Utility promptlyfor
TOTAL such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSI7S ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UT.QM SERVICE
APPL= FOR ON THE DAY THE 'WATER METER OR OTHER UT = SERVICE CONNECTION IS INSTALLED AT
L� AFPLICANrS PROPERTY,REGARDLESS OF'WI EN APPLICANT STARTS U M IZWG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 4;t� SOCIAL SEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL-
DATE
USE ONLY
DATEftECEIVED _ ...-____-_ CASH CH &--rr v RECEIVED BY