HomeMy WebLinkAboutUtility Company ApprovalATER
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L V
NAME L
ST LUCIE COUNTY WATER& SEWER DISTRICT
NEW CUSTOMER APPLICATION .
4 Aro-ro/d
�1 APR 3 0 2021
ST. Lucie County, Permitting
ACCT.#
SERVICE ADDRESS
Fort. Pierce, :FL.34945
SUBDIVISIONLOT L BLOCK
BILLING:ADDRESS
EMAIL 'DMPARRINOCc)DRHORTON.COM
PHONE cJ�i lcJ� MOVE IN/CLOSING DATE
'This application hereby requests and authorizes the Utllityto render water and/orsewage disposal
services to the premises described• above in 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 UtilkV'promptlyfor
such services In accordance with the established: rules and :regulations.
CUSTOMERS DEPOSITS ARE. NON NEGOTIABLE OR TRANSFERABLE.
EJ-APPLICANT AGREES THAT APPLICANT WILL SEGIN.PAYING:BASE FACH= CHARGES -TOR =-UTCCMP SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTffM UTILITY : SERVICE CONNECTION IS ; INSTALLED AT
APPLICANT'S moPERTY•, REGARDLESS 01? WSEN APPLICANT: STARTS UTII",ING THE AIETM AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSEC/FED ID --
NAME OF SPOUSE SPOUSE.SOCIAL-
`` ZOFFICE USE ONLY.
DATE -RECEIVED ✓?' - A CASH C # /�!G RECEIVED.BY