HomeMy WebLinkAboutUtility Company Approval ........... . . ....... .................................. ...... ....,. ..
�,J Lc!o 1:.. ST LUCIE COUNTY WATER&SEWER DISTRICT (SLCU)
'(, w
h NEW CUSTOMER APPLICATION Ol
ATER of J
SEWER ✓ RES NAME. � �'"
METER.SZ.-- M/F ACCT.#IRR
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5 SECURITY DEP SERVICE ADDRESS 3,-335 �
SERVICE FEE Fort Pierce, FL 34945
SAME DAY FEE SUBDIVISIONL�Q� LOT BLOCK
OVERTIME FEE `l �Q
BILLING ADDRESS 1 y ����- Ogf N6 T�IYL
METER INSTAL -
CFC/WATER EMAILADDRESS: DMPARRIN0013RHORTON.COM
FPUA CFC PHONE.• 19 l f�, MOVE IN/CLOSING DATE
CFC/SEWER
GUAR.REV. This application hereby requests and authorizes the Utilltyto render water and/orsewage disposal
services to the premises described.above in accordance with the Utilities present or future rates,rules and
^LATERAL regulations,which by reference are made a part of this contract.Applicant agrees to pay Utility promptly for
$ / i TOTAL such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE,
ElAPPLICANT AGREES THAT APPLICANT WML BEGIN PAMG BASE FACILITY CHARGES FOR THE UTILITY SERVICE -
APPL�D FOR ON THE DAY THE WATER METER OR OTHER UTILTT'Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY,REGARDLESS OF WHIN APPLICANT STARTS UTII,IZIlVG THE METER ANDIOR SERVICE.
CUSTOMERSIGNATURE Z Lkk& Clit SOCIALSEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL-
OFFICE
/� �r OFFICE USE ONLY yJ�/�
DATE-RECEIVED J,I`Z�o�/ CASH � /qe RECEIVED BY