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HomeMy WebLinkAboutUtility Company Approval ................................. .................... ........... -ST LUCIE COUNTY WATER&SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION ATER POMM n SEINER RES NAME QQ Q �f n 5 METER SZ. M/F ACCT.# r IRR CJ O SECURrCY DEP SERVICE ADDRESS $ �a l J I r 1 SERVICE FEE Fort Pierce, FL 34945 SAME DAY FEE SUBDIVISION6eEd "!©C V LOT BLOCK OVERTIME FEE F /��. � �C I r� Se)n METER INSTAL BIWNGADDRESS 64 �l/ j JoP CFC/WATER EMAILADDRESS: DMPARRIN0QQRH0RT0N.00M FPUA CFC PHONE 16Q)JJJ / / MOVE IN/CLOSING DATE CFC/SEWER GUAR.REV. This application hereby requests and authorizes the Utility to 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 $ i TOTAL such services in accordance with the established rules and regulations. CUSTOMERS DEPOSfrS ARE NON NEGOTIABLE OR TRANSFERABLE. -APPLICANT AGREES THAT APPLICANT MUM BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE APPIM FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT APPLICANT'S PROPERTY,REGA"LESS OF WEIEN APPLICANT STARTS UTILIZING THE METERAND/OR SERVICE. CUSTOMER SIGNATURE SOCIAL SECJFED ID — — NAME OF SPOUSE SPOUSE SOCIAL.- OFFICE OFFICE USE ONLY DATE-RECEIVED 3, CASH tjoM# /__UL RECEIVED BY