HomeMy WebLinkAboutUtility Company Approvalfi'` WATER
SEWER
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COMM
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M/F
IRR
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
/� OVERTIME FEE
00 METER INSTAL
31 7,5_ UQ . CFC/WATER
' ! FPUA CFC
CC- -00, CFC/SEWER
R' GUAR. REV.
LATERAL
TOTAL
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # 15�5_1145?1 -
SERVICE ADDRESS f9tho
SUBDIVISION -X�
ArMl,&-T
199
LOT
BILLING ADDRESS�U
EMAIL ADDRESS: �XD
PHONE it - S 9 MOVE IN/CLOSING DATE
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 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 UT ITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UI7LITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATU
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY