HomeMy WebLinkAboutUtility Company Approvaltr,�;UL' ,•=�. ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEIIVCUSTOMER APPLICATION
ATER
MM'
SEWER
✓ RES....
5 U METER SZ.
M/F
IRR
D
$ (�
SECURITY DEP
SERVICE FEE
SAME DAY FEE
_OVERTIME :FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ i TOTAL
SERVICE ADDRESS 5VCW7 je::l N/ ZV b%L.
Fort Pierce, FL 34945
SUBDIVISION l.b&7.. v
...... .... .
BILLING ADDRESS_
LOT aS BLOCKS:
/467[!' Aaf!.)q JIQ910
EMAILAD%%DRESS:. DMPARRIINp0
�0DJRHORTON.COM .
PHONE #A_�J.r ! 7 / oC MOVE IN/CLOSING DATE
This application hereby requests:and authorizes the Utility.to render -water and/orsewage disposal
services.to the premises described above in accordancewith 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
ElAPPLICANT AGREES THAT APPLICANT WILL BEGINPAYING BASE FACEEM CHARGES FOR THE UTILITY SERVICE
APPLIED FOR ON .THE DAY THE WATER METER OR OTHER UT=Y :SERVICE: COI1i1+TECTION IS INSTALLED:. AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS Urff Y'/TNG THE METERR. AND/OR SERVICE.
CUSTOMERSIGNATM cstCL: SOCIAL SEC/FED ID
NAME OF.SPOUSE SPOUSE SOCIAL -
OFFICE: USE ONLY
DATE -RECEIVED CASH :CHECK # RECEIVED BY