HomeMy WebLinkAboutUtility Company ApprovalSEWER
METER SZ.
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SECURITY DEP
SERVICE FEE .
SAME DAY FEE
OVERTIME FEE
METER INSTAL
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FPUA CFC
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
,P- //,�P.07ZAJ
ACCT. # /98 48
SERVICE ADDRESS. _ 3
Fort Pierce, FL 34945
SUBDIVISIOJA46 �"Q� LOT BLOCK_
BILLING
�r-gym'gAy' /-Z
EMAILADDRESS:! IMPARRINO_DRHORTON.COM
PHONE.#A%%�) l `33— !RI9 2C� MOVE IN/CLOSING DATE
This application hereby requests and authodies the Utility to 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTa, W SERVICE
{ I APPLIED. FOR ON TBE DAY THE WATER METER OR. OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
L --i APPLICANT'S PROPERTY, REGARDLESS OF WREN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 27777 SOCIAL SEC/FEDD ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK#!; RECEIVED BY.