HomeMy WebLinkAboutUtility Company ApprovalST LUCIE COUNTY WATER-& SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ATFA MM.
NAME: `'�.� ate' "
SEWER ✓ RES
METER SZ. M/F
ACCT. #
IRR
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� SECURITY DEP
SERVICE ADDRESS - C-
r
SERVICE FEE.
Fort: Pierce, FL 34945
SUBDNL�� ISION&lD LOT I - BLACK:
SAME DAY FEE
OVERTIME FEE
�y
. Ir�e�. dJV VC A �d J
METER INSTAL.
BILLING ADDRESS
CFC/WATER
EMAILADDRESS: DMPARRIN000RHORTON.COM_
FPUA CFC
PHONE i 0Q )) 9.92c; MOVE IN/CLOSING DATE
CFC/SEWER
GUARAEV.
This application hereby requests and authorizes the Utilityto render water and/orsewage disposal
services to the premise$ described -above in accordance with the:Utilities present:ar future fates, rules and
:LATERAL
regulatlons, which by reference are made a part of this contract: Applicant:agrees:to pay Utility promptlyfor
$ I i TOTAL
such services in accordance with the established rules and regulations.
-
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
-APPLICANT AGREES THAT APPL C�iNT VOLL BEGIN: PA19WG: BASE FACILITY CEL4RGES FOR THE 'OTQ=TY SERVICE
ApPI.IEDD .FOR ON - TER DAY THE: WATER METER OR OTMR . UjUffY SERVICE CONNEMON IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WMN APPLICANT STARTS UTI[.17. NG TEE METER AND/OR -SERVICE: .
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE SPOUSE SOCIAL
2 y OFFICE USE ONLY
J
DATE RECEIVED I AJ CASH• RECEIVED BY: Gt