HomeMy WebLinkAboutUtility Company ApprovalST LUCIE COUNTY WATER & SEWER D1STRlCT (SLCU
07i j
. r .
•:. NEW CUSTOMER APPUCA-nON
t f�w ATEIt wmM
SEWER, RES — NAME Ak,'*W
METER SL .�+ �..—
M/f ACCL it
_i_ IRR
$SECURRY w
SERVICE FEE
SAME DAY FEE
SUBDIVISION
J j�Jr pVERT1ME:FEE
LOT—AS-0— BLOCK_`
IETER.INSTAL BILLING ADDRESS
DD aQWATM EMAIL ADDRESS: .
R.
FPUACFC
PHONE MOVE IN/CLOSING DATE
-�.. CFMSEWER:
GUAR. REV. Thbapplkation hereby requests and authort es the Utility too render waterand/orsewagp disposal.
�- LATERAL servlees to the Premiss described above in accordance with the Utilities present or future rates, rules and
regulations, whkh.by reference are made.a part ofthls corttrac.L AppGcarrtagrees to
•�[J TOTAL SUCK senrf�es In accordance *kh the established rules and PaY Ut(lity PrOmPtiY for
CUSMMERS DEPOSITS ARE NON REG07"L,E ORiRANWWM ations:
•'yPLiCANr AGREES TEAT APPLICA1qT WILL B.EG N PATM BASE. F`Acujn:CHARGES PM MR AMM. PM ON 1= DAY T= WAnR MOM _ OR OZBEEL U= SEKVIC$
AYPLICCANT'B PROP ilTa�`Y SERVICE SON 13 DISTA �r pn 3'Y, REGARDLESS OF WitENAPPUCANT STARTS:-1MUX 4 TAND/OR SERVICE. AT
CUSTOMER SIGNATURE .
- SOCIALSEC,/FEp
NAME OFSPOUSE V, v - --
SFOUSESOCIAL
/ OFFICE USE ONLY
DATE RECEIVED f :/° aC I +D,p
��_ CHECK* '70/ RECEIVED Br G�