HomeMy WebLinkAboutUtility Company Approval1f\- WATER
7L SEWER
�$ METER SZ.
COMM
- RES
M/F
IRR
$ 8 SECURITY DEP
SERVICE FEE
SAME DAY FEE
�[/ (�j OVERTIME FEE
'3 T' 06 METER INSTAL
31 / _ UQ CFC/WATER
FPUA CFC
Q0. CFC/SEWER
00
GUAR. REV.
$ �a(� LATERAL
�! / • TOTAL
ST LUCIE COUNTY WATER Sc SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # LS�5—VQ --
SERVICE ADDRESS
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SUBDIVISION
BILLING ADD
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EMAIL ADDRESS: - "
PHONE # q6S— /} 60 V MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to render water and/or sewage disposal
regulations, which by reference are made a part of this contract. Applicant agrees to pay Utility
services to the premises described above in accordance with the Utilities present or future rates, rules and
promptly
such services in accordance with the established rules and regulations. for
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILrI`Y CHARGES FOR THE UTU ny SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTEER UIIUTI'Y SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK #
RECEIVED BY
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