HomeMy WebLinkAboutUtility Company ApprovalATER OMM
SEWER RES
METER SZ. M/F
• ��
is
1RR
0
$ SECURITY DEP
SERVICE FEE
SAME. DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV,
LATERAL
ST LUCIE COUNTY WATER St SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAMEAR
ACC17. # an g
SERVICE
N
Fort Pierce, FL 34945
SUBDNISION68eI4M�7 ply~' LOT BLOCK
BILLING ADDRESS I�UCa� /lYf' . aQ9CJ 9
EMAILADDDRREES}S:_ �f ! DJMPARRII{N�00-DRHORTON.COM
PHONE 4� )) r,13— / ,;� MOVE IN/CLOSING DATE
This appllcatlon 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
regulations, which by reference are made 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 THAT :APPLICANT WILL BEGIN PAAYING RASE FACILITY CHARGES FOR THE :UTILITY .SERVICE
.A.PPLICED FOR ON THE DAY THE WATER NXTER OR OTHER: T3MAW: SERVICE. CONNECITON IS INSTALLED AT
APPLICANT'S PROPERTY',_ REGARDLESS OF WD EN APPLICANT STARTS UTILIZING THE METLRANDIOR SERVICE.
CUSTOMERSIGNATURE l� SOCIAL SECIFED ID
NAME OF SPOUSE
SPOUSE SOCIAL-
OFFICE USE ONLY
DATE•RECEIVED 3, I9 .2( CASH Caen / RECEIVED BY
Jya