HomeMy WebLinkAboutUtility Company Approval4
ATER
OMM.
SEWER
t, RES
5 METER SZ;
M/F
IRR
�
rr
J�
$ _
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR: REV.
nn LATERAL
$ / v TOTAL
NAM
ST1UCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW: CUSTOMER APPLICATION
//v C-7 -0 A J.
ACCr.# /9BS �---a
SERVICE ADDRESS
Fora: Pierce, FL 34945
SUBDIVISIOJ'ez;` yi-w .l y LOT 3.
BLOCK
BIW NG ADDRESS 1
EMAILADDRESSi tDMPARRINO _DRHORTON.COM -
PHONE #!{ J 4 �"^ (� / 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 br future rates, rules: and
regulations, which by reference are made apart 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 .PAYING BASE FACILITY CHARGES FOR THE, UTHI Y SERVICE
APPLIED. FOR ON THE DAY THE WATIIt METER- OR. OTHER TITIL•Y' Y SERVICE COON IS INSTALZED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UT11371NG THE METER. AND/OR SERVICE.
CUSTOMER SIGNATURE 75,47� 71744237 SOCIAL SEC/FED ID
NAME .OF SPOUSE SPOUSE SOCIAL-
OFFICE USE ONLY
DATE -RECEIVED o��I�• CASH �##' RECEIVED BY