HomeMy WebLinkAboutUtility Company ApprovalATER OMM
EWER ✓ RFS..
METER SZ. M/F
IRR
$�� �. SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE.
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR, REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAM
SERVICE ADDRESS
Fort Pierce, FL 34945.
SUBDIVISION 6eeZt
j LOT BLOCK
BILLING ADDRESS % lJ L. 111Z/Q-- 2)A�t"IC— A� ���' N �K���7 ,
EMAILADDREEsS:_ 1DMPARRIN0_DRHORTON.COM
PHONE $� i J (c.�MOVE IN/CLOSING DATE
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 BASE FACILITY CHARGES FOR TEIE UIILTTY SERVICE -
APPLIIaD. FOR ON THE DAY THE WATER METER OR OTEEER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WEMN APPLICANT STARTS UTff T7,iNG TBE METER ANDIOR S.ER.Vi[CE.
CUSTOMER SIGNATURE T]Q7&7�7 SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE•RECEIVED CASH f RECEIVED BY