HomeMy WebLinkAboutUtility Company ApprovalSIB" Lt�a11L ��.
ATER
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SEINER
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METER 5Z.
M/F
IRR
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ f TOTAL
ST LUCIE COUNTY WATER &:SEWER :DISTRICT
NEW CUSTOMER APPLICATION
NAME J-
ACCT.# /jUL� �— !�O J
SERVICE AD
19
i1 APR 3 0 2021:
ST. Lucie County, Permitting
Fort_Pierce, FL 34945.
SUBDIVISION .
e0a
LOT BLOCK
BIWNGADDRESS ! 17� (�G `"rT /
EMAILADD`RESS: DMPARR1N06_DRHORTON.COM
PHONE *�+�� (��" � / 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 in►ith the.Utilities present:or future rates, rules and
regulations, which by reference are made a part of this contract. Applicant agrees to pay Utility promptlyfor
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 Uff= SERVICE
APPLIED FOR ON TI3E DAY THE: WATER. METER OR OTE ER UTIMY SERVICE .CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZ NG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE A4,d, 2t�,~ SOCIALSECjFED ID —
NAME:OF SPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY�A
DATE RECEIVED `1 `I' oK CASH Ac RECEIVED BY
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