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HomeMy WebLinkAboutUtility Company ApprovalST LUCIE COUNTY WATER& SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION ATER MM. NAME"' SEWER . :/ RES METER SZ. M/F • ACCT. # -( Pcrro �y): fi IRR $ SECURITYDEP SERVICE ADDRESS l40 ma-c-, . sERVICE FEE Fort Pierce, FL_34945 SAME DAY FEE SUBDNISION6��`t'!©i- LOT 1 BLOCK OVERTIME FEE � m' /�6 Y(� �go 9 METER INSTAL BIUJNG ADDRESSX_-&Q C:UG/yGf�- CFC/WATER. EmAILADDRESS: DMPARRINOODRHORTON.COM FRUA CFC PHONE WO ) J �c �cJ� / d. MOVE IN/CLOSING DATE CFC/SEWER GUAR, REV. This application hereby requests and authorizes the Utilltyto render water and/or sewage:disposal . services to the premises described above in accordance with the:Utilities present or future.rates, rules and n LATERAL regulations, WhIgh by reference are made a part -of this contract. Applicant:agreesto 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 WILL BEGIN PAYING: BASE FACILITY CHARGES FOR THE. UTII W SERVICE APPLW) ON:. THE DAY - THE WATER RIETER OR 01WR VIE[Iff SERVICE COMWXnON IS. INSTALLED AT _ .FOR APPLICANT'S. PROPERTY; REGARDLESS OF WHFNAPPLICANT STARTS U'IIfXN'G THE AMTTER ANDIORSERVICE. CUSfOMERSIGNATURE :SOCIAL SEC/FED ID. 7— . NAME OF SPOUSE SPOUSE.SOCIAL- OFFICE USE ONLY DATE -RECEIVED CASH / �'/L - RECEIVED BY