HomeMy WebLinkAboutSLC Water & Sewer ApplicationSEWER
/J METER SZ.
S., LEGUE
r-
� OMM
RES
M/F
IRR
$� (� SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ 1 TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME 1 4 jlv ���
ACCT. # / lJ 8 4U - /yi i -
SERVICE AD
Fort Pierce, FL 34945
SUBDIVISIOJgen lDt�7 LOT !
BILLING ADD
EMAILADDDRE55:. �QMPARRRI/ INO�0-D]RHORTON.COM
PHONE #OQ )) (��� ! � OZ MOVE IN/CLOSING DATE
BLOCK 1
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This application hereby requests and authorizes the Utilityto 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 THE UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FEED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY