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L,GULL Y- : ST LU.CIE COUNTY WATER & SEWER DISTRICT (SLCU)
'Y ���� '1- , NEW CUSTOMER APPLICATION
V�XATER MNI
NAME -7-0'"
SEWER RES
ACCT. #
METER SZ. M/F
3V V' �iLrNi
t:
IRR
SECURITY bEP
SERVICE ADDRESS
SERVICE FEE
Fort -Pierce, FL 34945
SUBDIVISION:�T'�%Ot� dJ� LOT J BLOCK
SAME DAY FEE
OVERTIME FEE
n
METER INSTAL
BILLING ADDRESS
CFC/WATER
EMAILADDRESs: DMPARRINO(CORHORTON.COM
FPUA CFC
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PHONEMOVE IN/CLOSING DATE
r{I�J u✓Jf l! / oG
CFC/SEWER
GUAR, REV.
This application hereby requests and authorizes the Utilityto render water and/or sewage disposal
services to the premises described above. in accordance with the Utilities present or future rates, rules and
LATERAL
/
regulations, which by reference ate made a part of this contract. Applicant agrees to pay Utility promptly for
such services in accordance with the established rules and -regulations. .
$ TOTAL
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
-APPLICANT AGREES THAT APPLICANT WII,L .BEGIN PAYING BASE FACILITY CHARGES. FOR THE UTIIIff. SERVICE
APPLM FOR ON THE DAY TBE. WATER METER OR- OTHER UTUJff SERVICE CONNECTION IS IiYSTALLED AT
APPLICANT'S PROPERTY; REGA"LESS OF WMN APPLICANT STARTS UTILEZ NG.TBE METER ANDIOR SERVICE. -
CUSTOMER SIGNATURE T>�N� CiiLZr.It9 SOCIAL SEC/FED lb
NAME OF SPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH_ CHECK# RECEIVED BY