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RECEIVED
°� - ST LUCIE COUNTY WATER & SEWER DISTRICT SL U
'l LLB t APR. ®2021
NEW CUSTOMER APPLICATION
ST. Lucie County, Permitting
ATER POMM
SEWER RES NAME �'�� 0�anl
METER SZ. M/F ACCT. S-
# F.
IRR
$ SECURITY DEP SERVICE ADDRESS.
SERVICE FEE
-Fort Pierce, FL 34945
SAME DAY FEE SUBDIVISIONID Jam' . LOT BLOCK.
OVERTIME FEE Q /�
METER INSTAL
BILLING ADDRESS
CFC/WATER EMAILADDRESS: DMPARRIN001)RHORTON.COM
FPUA CFC PHONE iderr)J ,3_ 99 2d. MOVE IN/CLOSING DATE
CFC/SEWER
GUAR, REV. This application hereby requests and authorizes the Utilityto render water and/orsewage.disposal ...
services to the premises described above in accordance with the Utilities present or future rates, rules and
LATERAL regulations, which by reference are made a part ofthis contract. Applicant agrees to pay Utility promptlyfor ..
$ f. TOTAL such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
F7-APPLICANT AGREES THAT APPLICANT WILL. BEGIlY PAYING BASE FACILITY CHARGES FOR THE UTff= SMVICE -
APPLIED.FOR ON THE DAY THE WATER METER OR OTHER; UMITY SERVICE CONNECTION IS INSTALLED AT
APPLICAN'T'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZYNG THE METER AND/OR SERVICE.
CUSTQMER SIGNATURE T>k;fd; SOCIAL SEC/FED ID :
NAME OF SPOUSE 'SPOUSE SOCIAL
OFFICE .USE ONLY,/.('�
DATE -RECEIVED CASH Ci @W# /7Cs RECEIVED BY .