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ST LUCIE COUNTY WATER &SEWER -DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME J14
o—r of
ACCT. #
SERVICE ADDRESS,
Fort Pierce, FL
34945
SUBDIVISIONG`�'�'&7j:1:
METER INSTAL i BILLING
CFCIWATER
FPUA CFC
CFC/SEWER
GUAR. REV.
j LATERAL
$ / i TOTAL
LOT , V
I/C
EMAILADDRESS: DMPARRINOODRHORTON.COM
PHONE A�3Q!) L-1,3— 9'? f -21 _ MOVE IN/CLOSING DATE
BLOCK
qI_1�9-0
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
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 BASF, FACILITY CHARM FOR =.UMLTiY SERVICE -
APPLIED FOR ON THE DAY THE WATER METER OR OTHER -UTILITY SERVICE CONNEMON IS INSTALLTD AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPIACANT:STARTS UTffMJ iTG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE .SOCIALSECIFEDID
NAME. OF SPOUSE
:SPOUSE SOCIAL-
OFFICE USE ONLY A,�
DATE RECEIVED r`J'tLi CASH cw@en /"l� RECEIVED BY
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