HomeMy WebLinkAboutUtility Company ApprovalS t .1"rc 5_LE?
V XATER MM .
SEWER REOS
METER SZ. MIF
IRR
$ SV SECURITY DEP
:SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
77-P jO TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU:)
NEW CUSTOMER APPLICATION
'� NAME i2W' AJ
ACCT. # J7
SERVICE
Fort Pierce, FL 34945
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BLOCK
BILLING ADDRESS of/� AzAt 4.4 -3Q9,0 9
EMAILADDRESS:. CiMPARRINOODRHORTON.COM:
PHONE I MOVE IN/CLOSING DATE.
This application hereby requestsandauthorizes the Utility.to render water and/or sewage disposal , I
services to the premises described above in accordance with the Utilities presentorfuture fates, rules And
regulations, which by reference are made a part of this contract. Applicant Pgreesto, pay Utility pr9mptly.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 TJIE:UMXIY SERVICE
APPLIED FOR ON THE DAY -THE WATER METER OR OTHER UTILITY .SERVICE CONNECTION IS. INSTALLED AT
APPLICANT'S FROPERTY,*EGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
6
CUSTOMER SIGNATURE Z24iXa, Pa&4i,;te- :,SOCIAL SEC/FED ID '17S —?,4�,"
7
NAME OFSPOUSE SPOUSE SOCIAL
OFFICE USE ONLY
:DATE -RECEIVED CASH -CHECK#RECEIVED BY