HomeMy WebLinkAboutSLC Water & Sewer Application..... ..... ...............:.._.......'y --�
L�"l'- LUr L
ATER MM
SEWER ✓ ROES
S METER SZ. M/F
1RR
$�
SECURITY DEA
- - --- - SERVICE -FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/Sf W ER
GUAR. REV.
LATERAL
$ 1 f rfliz TOTAL
ST LUCIE COUNTY WATER & SEINER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
,9- //P J?_-77) AJ
ACCT.
SERVICE
Fort Pierce, F�—
L-34945
N�"SUBDIVISIOD&7 42y LOT ! [ BLOCK
BIW NG AD
vC /uc &1K &/' /-Z 'n-)�gU'g
EMAILADDRESS:_ DMPARR1N0C_DRH0RT0N.00M
PHONE 6Q))VJ— W / 0, MOVE 1N/CL6SING DATE
This application hereby requests and authorizes the Util'rtyto render water and/orsewage 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, promptlyfor
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
E�APPLICANT AGREES THAT APPLICANT Wff L BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTff= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE T 4N,� dAA2ne SOCIAL SECTFED ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY