HomeMy WebLinkAboutUtility Company ApprovalAPR 3 2021 � ! �L • ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
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NEW' CUSTOMER APPLICATION
ST• Lucie county "*�•
ty., Permitting � > � .
ATER
OIv1M
SEINER
✓ RES
METER SZ.
M/F
D
IRR
$�
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ i
TOTAL
a�A./
ACCT. # AR
SERVICE ADD
Fort Pierce, FL 34945
SUBDIVISIONe&—a /Dc LOT ! BLOCK:..
BILLING ADDRESS
EMQILADDREss:. QM�PARR�INO ar_DRHORTON.COM
PH /
ONE / 9 2e;Z 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, 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.
PPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FAC11= CHARGES FOR THE 'UT.LGITY SERVICE
EliPIPTACANT'S
PPLIED FOR ON THE DAY THE WATER METER OR OTHER TITE= SERVICE COMMMON IS INSTALLED AT
PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UT.II V NG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSECJFEDID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED 3( 1g�Z-1 CASH 94WK# RECEIVED BY