HomeMy WebLinkAboutUtilities receiptWATER
COMM
SEWER_RES
METER SL M/F
—t- — IRR
orco
$ �/ bQ SECURfTYDEP
SERVICE FEE
SAME DAY FEE
i ' r OVERTIME FEE
t)V METER INSTAL
L73 UQ CFC/WATER
� { � FPUA CFC
-J
C.n42 J,DZ5 CFC/SEWER
bLl GUAR. REV.
�} LATERAL
$ 4) r TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
SUBDIVISIOW,d4a, 'C"UJ � LOT,.tL2. BLOCK
BILLING
EMAIL ADDRESS_ � j 2 '
PHONE#(6 0)) MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Ufilityto 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.
tom, APPLICANT AGREES THAT APPLICANTP WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE DTTLITY SERVICE
II A,L. jl APPLIED FOR ON THE DAY T� WATER METER OR OTHER �f �'r'�' SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UIUXO LTG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSEC/FEDID —
NAME OF SPOUSE
SPOUSE SOCIAL
DATE RECEIVED &fC'Z�r CASH OFFICE CH CKK #LY/e��/ 7 vo� RECEIVED BY