HomeMy WebLinkAboutUtility Company ApprovalY SEWER
METER SZ.
� OMM
RES
M/F
1RR
$5bv
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
/ � d $ / 10 TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME 3� 11 �'6AJ
ACCT. # VQ0 c---' I M
SERVICE
q3l�
Fort Pierce, FL 34945
SUBDIVISION6�"OC 42�C7 LOT BLOCK
BILLING
,/C- /jc I� �&A! f-Z , -� UgU /)
EMAILADDRESS: DMPARRIN00-DRHORTON.COM
PHONE �3Q i� MOVE IN/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.
a-.APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTff-M SERVICE
APPI,M FOR ON THE DAY THE WATER. METER OR OTHER UTI= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING NG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 7307 SOCIAL SEC/FED ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY