HomeMy WebLinkAboutUtility Company ApprovalW. N
® I t_�L ST LUCIE COUNTY WATER SEWER DISTRICT (SLCU)
w NEW CUSTOMER APPLICATION
AlER MM:
SEWER tf n S
METER SZ M/F
IRR
$ �bv SECURITY DEP
SERVICE FEE -
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
-_GUAR._R-EV.
,r LATERAL
$ / -/ r d 10TOTAL
NAME A 0`Z)/y
ACCT. #
SERVICE ADDRESS
Fort Pierce, FL 34945'
SUBDNISION !Q� LOT BLOCK
AILLING f 7C/v/I�Gi� dJUC /+D old
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EMAILADDRESS:,_ DMPAR/RIINNOrMADRHORTON.COM
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 with the Utilities present or future rates,-rutes.: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_
APPLICANT AGREES THAT APPLICANT WHO, BEGIN PAYIN'G.BASE FACILITY CF ARGES FOR THE U=W SERVICE
APPLIED - FOR ON - THE DAY TEE :.WATER A IETER OR OTHER. UTI M - SERVICE CONNECTION IS. INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UT11LJZ LTG TEE METER AND/OR SERVICE.
CUSTOMER SIGNATURE T>Eir� _ �l;AA a. SOCIAL SECJFEDID
NAME OF SPOUSE SPOUSE SOCIAL
OFFICE USE ONLY DATE -RECEIVE D �`1 �`�l CASH # A17- RECEIVED BY, 4adg=