HomeMy WebLinkAboutUtility Company Approval��'tk`; LUCIEI, -
V ATER OMM
SEWER ✓ RES
METER SZ. M/F
1RR
$ (� SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFc/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ / / i TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME Jk- 17 9W' "
ACCT.# /9848 m--- laV/
SERVICE
Fort Pierce, FL 34945 `
SUBDIVISION(.44 /Or� 4Z'�7 LOT J BLOCK
BILLING
�vC /vc /�Z '_3'-�9'0'9
EMAILADDRESS:. �QM2PAR/R11N0(W.QRHORTON.COM
PHONE �� �� r�✓�f (� / o� MOVE IN/CLOSING DATE
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, 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 FACILITY CHARGES FOR THE UMW SERVICE
APPLIED FOR ON THE DAY THE WATER MJT METER OR OTHER UTH Y SERVICE CONNECITON IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED _ _ CASH CHECK##' RECEIVED BY