HomeMy WebLinkAboutSLC Water & Sewer Customer ApplicationTER
SEWER
METER SZ.
OMM
RES
M/F
IRR
$� C? SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL__
TOTAL
NAME
ACCT.
SERVICE
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
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188�8 �-- �Jq `Alc�- A 7b Y
Fort Pierce, FL 34945 SUBDIVISION__2f �� LOT 113 BLOCK^—1
BILLING
�rzru /LJC 3; �94
EMAILADDRFSS: DMPARRIN000RHORTON.COM
PHONE dk,-kX �
N.-
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 apart 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 THE UTILITY SERVICE -
` I APPLIED FOR ON TEE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS ]INSTALLED AT
1L._rllr) APPLICANT'S PROPERTY, REGARDLESS OF WEEN APPLICANT STARTS UTUAZING THE METER ANDIOR SERVICE.
CUSTOMER SIGNATURE Z2iif� 7a4Az SOCIAL SEC/FED ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY