HomeMy WebLinkAboutUtility Company Approval9!11� LlarGE ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ATER MM
SEWER RES NAME
METER SZ. M/F ACCT. #
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IRR
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$ SECURITY DEP SERVICE ADDRESS
SERVICE FEE. Fort Piercer FL 34945
SAME DAY FEE SUBDNISIONI�E�'b&7 LOT BLOCK
OVERTIME FEE, J
.METER INSTAL
BILLING ADDRESS = (J Iy��- cb�'/C %u!✓
CFC/WATER EMAILADDRESS: DMPARRIN000RHORTON.COM
FPUA CFC PHONE o�) e3— f MOVE IN/CLOSING DATE
CFC/SEWER
GUAR. REV. 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
LATERAL regulations, which by reference are made a part of this contract. Applicant agrees to_pay Utility promptlyfar
TOTAL 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 RACIGITY CHARGES FOR UIUI Y SERVICE -
APW W) FOR ON THE DAY THE WATER METER OR OTUM UTHMT SERVICE: COI1#ME UON IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING. THE METER ANDIOR SERVICE.
CUSTOMER SIGNATURE iNCL _ 1127M . SOCIALSECJFED ID —
NAME OF SPOUSE SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED 3' �� i,f CASH RECEIVED BY