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ST-LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. 4L- A?
SERVICE ADDRESS C
Fort Pierce, FL:34945:..
SUBDIVISIONOEzk_!ll6c LOT BLOCK
BILLING ADDRESS &111ZJ� 094"VC A6 A m
EMAILADDRESS:, DIMPARRINOVORHORT.QN.COM
PHONEct_�M MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to render water and/or sewage disposal
servicesto the premises described above iniaccordance'with the Utilities present or future rates, rules and
regulations, which by reference are made a part of this contract. Applicant agreesto pay Utility promptly for
such services in accordance with the.est.ablished: rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE
APPLICANT AGREES THAT APPLICANT WML BEGIN PAYING BASE FACE= CHARGES FOR ='Urff_XW SMV14M
APIRLM]FOR ON TEIE DAY THE WATER METER OR OTHER =1TY SMV10E,C0N?QECTI[0N IS.:INSTALLED. AT
APPLICANT'S PROPERTY REGARDLESS OF WEIMN APPLICANT STARTS UTHMING THE METER AND/OR.SERVICCE.
CUSTOMER SIGNATURE =47111 CliLLI Ld SOCIAL SEC/FEU ID
NAME OF SPOUSE
SPOUSE SO CIAL-
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY