HomeMy WebLinkAboutUtility Company ApprovalS.-LlUu, L:. = ST LUCIE COUNTY WATER &SEWER DISTRICT: (SLCUj:
NEW' CUSTOMER APPLICATION
AN"N''M
AT£R MM
SEWER RES
NAME
5METER sz. nn/F
ACCT. #
IRR
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$ SECURITY DEP
SERVICE ADDRESS d�
SERVICE FEE
Fort Pierce, FL-34945
C��JE'�l D�
SAME DAY FEE
SUBDNISION LOT BLOCK
OVERTIMETEE
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METER INSTAL
BILLING ADDRESS ; <Z)ef. /`" �--
CFC/WATER
EMAILADDRESS:. DMPARRIN00-13RHORTON.COM .
FPUA CFC
PHONE'4220 ` �J / c;z MOVE IN/CLOSING DATE
CFC/SEINER
GUAR.:REV.
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This application herebyrequests and authorizes the Utility to render water and/or sewage disposal - c
services to the premises described above in accordance with the Utilities present or future rates, rules and
LATERAL
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regulations, whfch by reference are made a part of this contract Applicant agrees to. pay Utility promptly for: ap
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such services In accordance with the established,rules and regulations.
$ i TOTAL
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT. AGREES: TEAT APPLICANT WIM BEG N :PAIMVG BASE FACILITY CHARGES FOR THE UT ny SERVICE
APPLID? FOR ON TIIC+ DAY THL WATER METER OR OTID�t UTILITY 'SERVICE CONNECTION IS IlVSTALLED AT
APPLICAN s PROPERTY, REGARDLESS OF'WHEN APPLICANT STARTS UT-MVJNG THE METER AND/OR SERVICE. ....
CUSTOMER SIGNATURE �'
4'.= . SOCIALSEC/FED ID
NAME:OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
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DATE•RECEIVED &l -41
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CASH Giff0tk v RECEIVED BY Q v
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