HomeMy WebLinkAboutUtility Company ApprovalATER
SEWER
7!OMM
✓ RES
5 METER SZ.
M/F
IRR
$
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
WON#=
ACCT. #
SERVICE
Q�
'Fort Pierce, FL 34945
SUBDNISIONL�' gyi,6&7 J�C LOT BLOCK_
BILLING ADDRESS
EMAILADDRESS:. FDJM2P2ARRRIIN00-DRHORTON.COM
PHONE c—� ,,� `c�J� /MOVE1N/CLOSING DATE
This application 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.
aAPPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACH= CHARGES FOR THE iJIRM SERVICE
APPLIES FOR ON THE DAY THE WATER METER OR OTHER U MITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 77� ate SOCIAL SEC/FED ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY