HomeMy WebLinkAboutUtility Company ApprovalST LUCIE COUNTY WATER &:SE`NER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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SEWER RES.
NAME
METER SZ. M/F
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ACCT. # / U
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SECURITY DEP
$ gADDRESS:
SERVICE
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SERVICE FEE:
Fort Pierce, FL 34945
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SAME DAY FEE
OVERTIME FEE
METER INSTAL..
CFC/WATER
FP.UA CFC
CFC/SEWER
GUAR: REV.
LATERAL
$ 91)1 Ad TOTAL
..SUBDIVISION !QC LOT BLOCK
BILLINGADDRESS
EMAIL ADDRESS DMPARRINORHORTON.COM:
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P. HONE t1� �1 fcJ � X IM
MOVE IN LOSING DATE
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This application hereby requests'and authorizes the Utiiit.vto render water and/or sewage disposal
services to the premises described above In accordance with the Utilities present or future rates, rules and
regulations, whlch:by reference are made: a part o is 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 IRECAM PAM NG BASE FACIMTY CHARGES FUR: THE UTU= SERVICE
APPLM .FOR ON. THE DAY THE WATER METER OR :OTBER UTILITY SERVICE CONNECTION IS INSTALLED. AT
APPLICANT'S PROPERTY, REGARDLESS OF WE EN APPLICANT STARTS UTMMNG:THE METER AND/OR SERVICE..
CUSTOMER SIGNATURE SOCIAL SEC/FEDD ID
NAME.OF SPOUSE SPOUSE SO, CIAL•
OFFICE USE ONLY
RECEIVED BY
DATE: RECEIVED 3' ia�-Zt GASH GL