HomeMy WebLinkAboutUtility Company Approval9111fo L��!. I ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)'
NEW CUSTOMER APPLICATION
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ATER MM
SEWER ✓ RES
W METER SZ.. M/F
IRR
O
$� SECURITY DEP
'SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER:..:
-FPUA CFC
CFC/SEWER
GUAR..
i.ATERAL
$ / / TOTAL
NAMEAj
ACCT. # /99 q0 0
SERVICE ADDRESS
Fort.Pierce, FL 34945
SUBDIVISION sly LOT l.. BLOCK
BILLING ADDRESS ./��f�—tUC /�� T.2gd �I
1
EMAILADDREss., DMPARRIN00-DRHORTON.COM
PHONE,(,a)J � ✓ MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utilftyto render water and/or sewage disposal
services to the premises described above lh accordance -With the Utilities present or future rates, rules and
regulations, whlch by reference are made a part of this contract Applicant agrees to pay Utility promptlyfor
such services In.accordance-with the established rules and regulations. .
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR. TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT VVML BEGIN PAYING ;RASE FACHd.TY CHARGES FOR THE UI,MXff SERVICE
iAPIEM FOR ON TILE DAY THE. WATER NIETEB. OR OTHER; WITH= SERVICE - CONAVECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WEI EN APPLICANT STARTS U=XEING TEE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 7�tarrL:. CeiltZlZd SOCIAL SFCJFEo 1D
NAME OF SPOUSE
SPOUSI SOCIAL•
OFFICE USE ONLY
DATE -RECEIVED ��I� "7Z� CASH f RECEIVED BY