HomeMy WebLinkAboutUtility Company ApprovalVATER OMM
SEWER ✓ RES
S METER SZ. M/F
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$� SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
% n LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME _-- �e—
NEW CUSTOMER APPLICATION
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ACCT. # / l� 8 `7' U
SERVICE AD
Fort Pierce, FL 34945
SUBDIVISION6?` 067
BILLING ADD
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EMAILADDDRREESS: �DJMPARRIIN�DRHORTON.COM
PHONE,6Q�) ( ! MOVE IN/CLOSING DATE
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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 or future rates, rules and
regulations, whleh 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CE ARGES FOR THE+ =ITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SECIFED ID
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY