HomeMy WebLinkAboutUtility Company ApprovalV ATER .. MNI
SEWER. ✓ RES
METER SZ. M/F
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
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FPUA CFC
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ST LUCIE COUNTY WATER &: SEWEk DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
1�_D14- A�4�97-OAI
ACCT.#
SERVICE ADDRESS
'Fort Pierce, FL 34945
SUBDIVISIONOJ_—Z 'OD&� . LOT BLOCK . 4
BILLING
EMAILADDRESS: DMPARRRINN00-D�RHORTON.COM
PHONEA# )J. VJ_ J 12d� 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:promptlyfor
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:TBE UDLITY SERVICE
,APPLIED FOR ON THE DAY -THE .WATER METER .OR OTHER UTILITY SERVICE .CONNECTION W . INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTH IMG THE METER AND/OR SERVICE.
CUSTOM ER SIGNATURE =77 F7,777eSOCIAL SEC/FED ID _
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY