HomeMy WebLinkAboutUtility Company ApprovalV WATER
SEWER
METER SZ.
........... ..... ...... ..... .. ..... I .. .........
Ur CIL". ST LUCIE COUNTY WATER,& SEWER DISTRICT (SLCU)
NEW CUSTOMER AIPLICAT16N
R!
COMM VRES
M/F
IRR
$ a5 VA, Off SECURITY DEP
SERVICE FEE
ACCT.
SAME DAY FEE SUBDIVISION;
OVERTIME FEE
21,3q1_00 METER INSTAL 1. BILLING ADDF
CFC(WATER
FPUA CFC'
CFC/SEWER
GUAR. REV.
LATERAL
$ 600 TOTAL
1557Vo*? 3 3)-
, , 53 -71 Juq ss
...... . . . . . . .
73
Lo-�__ .5_ BLOCK
EMAIL ADDRESS:
PHONE #.L7057 MOVE IWCLOSING DATE
This application hereby requests and authorizes the Utilityto renderwater and/or sewage. disposal
services to the premises described above: iri,accordance with the Utilities present orf6ture rates, rules and
regulations, which. by, reference are madea' part of this contract.' Applicant agrees to. pay Utility promptly for
such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE WON NEGOTIABLE. OR TRANSFERABLE
APPLICANT AGREES THAT APPLICANT WILL _BF,
GIN PAYING BASE FACILITY CHARGES FORME UTILITY SERVICE
XQAPPLIED FOR ON THE DAY THE WATER METER OR OTHER UTHM SERVIC1Z'C0MWMoN IS INSTALLED
AT
APPLICANT'S PROPERTY, REGARDLESS OF WEMN APPLICANT STARTSZTMIZINGTHE METER AND/OR SERVICE.
CUSTOMER SIGNATURE f ..... ... . . SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL
'DATE RECEIVED OFFICE USE ONLY
CASH CHECK 61fflz2— RECEIVED BY _Aa�z�e