HomeMy WebLinkAboutUtility Company Approval�,T ! ,( �f �� - ST LUCIE COUNTY WATER &SEWER: DISTRICT (SLCU)
'WMit it NEW CUSTOMER APPLICATION
ATER MM
SEWER RES . NAME Flyer/y
METER SZ. . M/F �---
IRR .
0
$ � � SECURITY DEP SERVICE ADDRESS..':
SERVICE FEE. Fort Pierce, FL.34945
SAME: DAY FEE119,
:..:SUBDNISION0_a�_iQLOT BLOCK
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ / !/ !J. TOTAL
BILLING ADDRESS 7c./D IYZ-W - 09fVC / ` & m - 1�6wlo
EMAILADDRESS:_ DMPARRIN00-DRHORTON.COM
PHONE #lI �J ~ . f 7 / : MOVE.IN/CLOSING DATE
This application hereby requests and authorizes the Ublityto renderwaterand%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:w)th the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
ED:APPLICANT AGREES THAT. APPLICANT WII�L: -REGIN :PAYING BASE FACILITY CHARGES FOR :THE UTH:ITY SERVICE . .
APPLM' FOR ON' = DAY THE WATER METER OR .OAR UIfIY SERVICE :CONNECTION IS INSTALLED. AT
APPLICANT'S PROPERTY, REGARDLESS OF VAUEN APPLICANT STARTS UTff-JYWG ME AMER AND/OR SERVICE.
CUSTOMER SIGNATURE T�WClitiL2itd SOCIAL SEC/FED ID -
-
NAME.OFSPOUSE SPOUSE SOCIAL -
OFFICE USE ONLY W
DATEAECEIVEQ CASH CHECK # RECEIVED BY w
w.
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