HomeMy WebLinkAboutUtility Company ApprovalATER
N/ SEWER
METER SZ.
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IRR
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SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
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FPUA CFC
CFC/SEWER
GUAR. REV
LATERAL
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ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME �,-AE
NEW CUSTOMER APPLICATION
9�/J
ACCT. # 1Q,0848 '719,
SERVICE ADDRESS 900
Fort Pierce, FL 3'"�4945
SUBDIVISIOJeenQrQ� Jam`'
BILLING ADD
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LOT J `!
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EMAILADDRESS: �DyM�rP2ARRJIN0
�0-D}RHORTON.COM
PHONE(IcJ�J!� / d. MOVE IN/CLOSING DATE
BLOCK
131,29,07
This application hereby requests and authorizes the Utilltyto 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 UTILITY SERVICE
aAPPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLTCANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UMIZING THE METER ANDIOR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY