HomeMy WebLinkAboutSLC Water & Sewer Application;. J.Irv-
ATER MM
SEWER RES
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SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
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FPUA CFC
CFC/SEWER
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LATERAL
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU).
NAME LI)
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NEW CUSTOMER APPLICATION
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ACCT. #
SERVICE ADDRESS / / 1�
Fort Pierce, FL 34945
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BILLING ADD
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EMAILADDRESS: �DMPARRENN0a_QRHORTON.COM
PHONE,OQ)) t5.5r / 2,� MOVE IN/CLOSING DATE
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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 promptlyfor
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE_
APPLICANT AGREES THAT APPLICANT WILL BEGINPAYING BASE FACT= CHARGES -FOR TEE UM9MITX SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTEITR UTffMy SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WREN APPLICANT STARTS UTILDUNG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FEDD 1D -'
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY