HomeMy WebLinkAboutUtility Company ApprovalV XATER
MM
SEWER
✓ RES
5 METER SZ.
M/F
II
SECURITY DEP
SERVICE FEE
SAME DAY FEE
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
h,
NAME
NEW CUSTOMER APPLICATION
ACCT. #
SERVICE
3 5 o2 "% 'n
`22
Fort Pierce, FL 34945
SUBDIVISIONi�'��"06 Ir—_ LOT o2 BLOCK
OVERTIl11lE FEE
METER INSTAL BILLING
CFC/WATER
FPUA CFC
CFC/SEWER
.GUAR. REV.
LATERAL
TOTAL
EMAILAD%DRESS:. DMPAR/RIINOOD-DRHORTON.COM
PHONE #AMOVE IN/CLOSING DATE
I-11)Q910 9
This application hereby requests•and authorises the Utility to render.water andjorsewage disposal
services to the premises described above in accordance with the Utilities present ar 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE 1111= SERVICE
APPLIED :FOR ON THE DAY THE WATER METER OR: OTHER UTH= SERVICE' CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE NIETERAND/OR SERVICE,
CUSTOMER SIGNATURE =�L� Qi 1U Z9 SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATERECEIVED CASH CHECK# RECEIVED BY