HomeMy WebLinkAboutUtility Company ApprovalUr GIE 'ST LUCIE COUNTY WATER & SEWEK DISTRICT (SLCU).
NEW CUSTOMER APPLICATION
V XATER OMM
SEWER t,�IRES.
ME -TER SZ. :MIF
�IRR
$ 0-1 SECURITY DEP
n
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
NAM
ACCT.
P_ llva7zlj
I . : APR 30 20
Z
L UCi.e C, Uny, Per fitting
SERVICE ADDRESS '71 LP (jam r U ( 121 FULLA2 r/ I
Fort Pierce, FL 34945'
11�7
SUBDIVISIO LOT J BLOCK'
BILLING ADDRESS: A6
-
EMAILADDRESS:.. DMPARRIN001)RHORTON.COM:
PHONEIOQ,) V-3�--a2c;z MOVE IN/CLOSING DATE
This application hereby requestsand authorizes the UtilltVto render water andlorsewage, disposal
services to the premises described abovein: 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 promptlyfor
suchservices; In- accordance m4th the. established -rules and regulations, -
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERAPLE.
-APPLICANT AGREES MIL
THAT APPLICANT WI: EEC AN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
AIP131M FOR ON TEIE DAY THE. WATER -AffTKR OR OTHER' TTIU= SERVICE - CONNECTION I$'INSTALLED AT
APPLICANTS PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTMMffG THE NMTER AND/OR SERVICE
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OFSPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY.
DATE -RECEIVED CASH... Cww": RECEIVED BY'A�