HomeMy WebLinkAboutUtility Company Approvalp ?3
LU E IfL �!, ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU), ?�
°Oy' 'I ` `r NEW CUSTOMER APPLICATION
r t�
ATER ..
MM
SEWER
_ RES
METER SZ.
M/F
D
IRR
$ (�.
SE CURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
,�f nn
$ / f
TOTAL
y
NAME
r�-C`-DAI -
ACCT. #
SERVICE ADDRESS�/'�
'Fort Pierce, FL 34945
�j ��o [�
SUBDNISION{_'�r`� LOT BLOCK /
..
A
BILLING ADDRESS _ L_ � /y - UC A � A� 3Q9e n
EMAILADDDRESS:. �DJMPAR/RIINNOOD-DRHORTON.COM
PHONE # ) (3-5_ !! / ,� __ __ MOVEiN/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 Utilitypromptly for
such services in accordance.with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES. THAT APPLICANT WILL BEGIN PAYING BASE FACIIM CHARGES FOR THE UMM SERVICE
APPLM) FOR ON THE DAY THE WATER METER OR OTHIIZ - UTH= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTIIJZIlVG T19E'METE.R AND/OR SERVICE: .
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE :SPOUSE SOCIAL
OFFICE USE ONLY
DATE -RECEIVED :CASH CHECK# . RECEIVED BY