HomeMy WebLinkAboutUtility Company ApprovalL�o 4 Lm O r ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
- ATE
MM
SEWER
✓ RF5
METER SZ.
M/F
IRR
$ 06�-
SECURITY DEP -
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SE.WER
GUAR. REV.
LATERAL
$ / fy (�. TOTAL
SERVICE ADDRESS ✓ 3 �G �iY1�c�G �/
Fort Pierce, FL 34945
. is Q
SUBDIVISION. LOT [J BLOCK..
BILLING ADDRESS % W &/11efL 11J PC Au � lii !d /
EMAILADDRFSS:. DMPARRINO&DRHORTON.COIUI
PHONE � 99 / c�z MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to render water and/orsewage disposal
services to the premises described. above in accordance with the Utilities present or future rates, rules and
regulations, whlch by reference are rnit& 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 THATAPPLICA.NT WILL BEGINTAYING BASE FACILITY CHARGES FOR:TSE UTHxTy SERVICE
APPLIED FOR ON :THE DAY TiEfE QVATEitt METER OR OTiHER UTILII'Y SERVICE CONNECTYON I;5 INSTALLED: AT
APPLICANT'S PROPERTY, REGARDLESS OF'OVHC" + N APPLICANT STARTS UTH MNG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE Z�i44.CL. . Clilhuti SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL-
/(� OFF10E-USE ONLY
DATERECEIVED �. l -r" �� CASH Cam#- "6 RECEIVED BY �l.J