HomeMy WebLinkAboutUtility Company ApprovalATER
MM:
SEWER
✓ RES
J METER SZ.
M/F
O
IRR
$�
SECURITY DEP
SERVICE FEE:
SAME -DAY FEE
OVERTIME FEE
METElf INSTAL
CFC/WATER .
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
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$ �. L/
TOTAL
ST.LUCIE COUNTY WATERAI SEWER: DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME
SERVICE
Fort Pierce, FL 34945 _
SUBDIVISIONf Ot LOT 16;2, BLOCK_
BILLING ADDRESS
EMAIL -ADDRESS:. QMPARRIN00-ORHORTON.COM
PHONE dc5Q) 433f !? / c7 MOVE IN/CLOSING DATE
This application hereby requests -and authorizes the Utility to 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 a part'ofthis contract. Applicant agrees to. pay Utility promptiy: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 B%1;I`Y ]BASE FACiCHARGES FOR THE UTILITY SERVICE
APPIM FOR ON THE DAY THE WATER METER OR OT1HR_TJTTWY .SERVICE COWiECTION IS -.INSTALLED. AT
APPLYCANT'S PROPERTY, REGARDLESS OF WEEN APPLICANT STARTS-TITILUING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE G/LC1: SOCIAL SEC/FED ID —
NAME OF SPOUSE - SPOUSE SOCIAL•
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY