HomeMy WebLinkAboutUtility Company ApprovalATER MM
SEWER ✓ AES
METER SZ. M/F
IRR
$J- SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR.. REV
LATERAL
/ 1 TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
.NEW CUSTOMER APPLICATION
4 //,P a-7-6 A]
ACCT.
SERVICE ADDRESS
Fort Pierce, FL 34945
SUBDNISION�lD&7 LOT /0 13LOCK
BILLING ADDRESS J''' C.�-GI f' 4 J�VC
EMAIL ADDDRREES��S: IDDM�PARRRII N OO-DRHORTON.COM
))PHONE #cJ� (cJ�f / / MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utilityto 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: apart 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 FORTRE UTILITY SERVICE
APPM D FOR ON: THE DAY THE 'WATER METER OR . OTHER UTHITY - SERVICE .CO1MCTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF VMEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSEC/FED ID _
NAME OF SPOUSE
SPOUSE SOCIAL•
=OFFICE USE ONLY
DATE -RECEIVED CASH CHECK # RECEIVED BY