HomeMy WebLinkAboutUTILITY X WATER COMM ST. LUCIE COUNTY UTILITIES- P.O//. BOX 728, FT. PIERCE, FL 34982
SEWER RES NAME**
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METER SZ. M/F ACCT.#
IRR
$85 SECURITY DEP SERVICE ADDRESS _SF�'j�� ^ �f 11✓�• f Jz 'y
SERVICE FEE 1(? ' _3' `/�
SAME DAY FEE
SUBDIVISION IRE LOT ��j BLOCK
OVERTIME FEE ,✓�
$434 METER INSTAL BILLING ADDRESS 1 j ti- ���K�11/' `-rr (3 ill call �:Ler
CFC/WATER EMAIL ADDRESS:_ =� Q�J U, �> ra /'yJC %may✓� i' 'y'
FPUA CFC ;-- n_
PHONE#�,� I t ,/C,� /.1 MOVE IN/CLOSING DATE 7�
CFC/.SEWER
GUAR. REV. This application hereby request 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
LATERAL and regulations,which by reference are made a part of this contract.Applicant.agrees to pay Utility
$519 TOTAL promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER
SIGNATURE** SOCIAL SEC/FED ID**
NAME OF SPOUSE SPOUSE SOCIAL SEC.
OFFICE USE ONLY
DATE RECEIVED CASH CHK# RECEIVED BY
I acknowledge Base Facility Charges beginning for water and/or wastewater on the day the meter and/or service is installed by
the County,regardless of when a customer connects to or starts utilizing the meter and/or service.
I acknowledge upon activation of service,I will be billed and am obligated to pay the Base Facility Charges.