HomeMy WebLinkAboutUtility Company ApprovalL, ,(`; ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
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d �} NEW CUSTOMER APPL[CATION
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WER ✓ R>=S NAME�
S.METER Sz. M/F ACCT. it
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IRR
- • ' $ 0 SECURITY DEP.. SERVICE ADDRESS =3 3 Q/ � `'f''{i
SERVICE FEE' Fort Pierce, FL 34945
SAME DAY FEE SUBdIVIStONC��='�`GID LOT ! BLOCK
OVERTIME FEE
.METER INSTAL
BIWNG ADDRESS
CFC/WATER EMAILADDRESS: DMPARRINO[cr1DRHORTON.COM
FPUA CFC 46 )
.PHONE MOVE IN/CLOSING DATE
CFC/SEWER
GUAR, REV, This application herebyrequests:and authorizes the Utilityto render water and/orsewage disposal
services to the premises described• above in accordance with the Utilities present or future rates, rules and
,r� n LATERAL regulations, which by reference are made a part of this contract. Appllcant agrees to -pay Utility promptly for
$ ./ TOTAL 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 FACII.M CHARGES FOR THE.UTILnY SERVICE
APPLIED . FOR ON ..THE DAY THE WATER METER OR: OTHER UTIL[ r Y SERVICE CONNECTION IS 1NSTALLED AT .
APPLICANT'S PROPERTY, REGARDLESS OF' WHEN. APPLICANT STARTS 'DTMTMZ G.THE NIETERAND/OR SERVICE.
CUSTOMER SIGNATURE
iltlL CLthlaZ� SOCIAL SEC/;FED ID
NAME OF SPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED 5, CASH WEE" �_ . RECEIVED BY