HomeMy WebLinkAboutUtility Company ApprovalL UINJL
V ATER mm
SEWER
EWER t," RES
METER SZ.. M/F
IRR
O
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
-METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. -REV.
LATERAL
77 TOTAL
ST:LUCIE COUNTY WATER :& SEWER DISTRICT (SLCU).
NEW -CUSTOMER APPLICATION
ACCT. #
SERVICE ADDRESS 306 ��AJ;2T-
Fort Pierce, FL.34945
SUBDIVISIONO,
i .4&7 j . r_7 LO . T SS'BLOCK.
7
BILLINQ ADDRESS 6,41111,e_
EMAIL ADDRM.:_QM PARRI NO@DRHORTON.COM
PHONE MOVE IN/CLOSING DATE
This application hereby- requestsand authorizes the Utility to render:water and/or sewage disposal
services o the premises described above In accordance with the btliffies present or future rates, rule . s . and
regulations, which by reference aremade a part of this contract, ntract. Applicant agrees. to pay Utility prarbOtly for
such services in accordance with the established. rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
EDAPPLICANT AGREES THAT APPLICANT WILD BEGIN PAYING BASE FACILITY CHARGES FOR THE UTff_JTY:SElXV10E
AM-11M FOR ON THE DAY THE WATM METER. OR OTHER 'UTMITY. SERVICE':CONNECTION IS MTAII" AT
'A_ppLjCAj%WS PROPERTY, REGARDLESS OF WHEN APPLICANT:STARTS UTME&ING THE METER -AND/OR SERVICE
?Z71
CUSTOMER SIGNATURE SOCIAL SEC/FED ID-
NAMEOF SPOUSE SPOUSE SOCIAL -
OFFICE' USE ONLY'
DATE -RECEIVED- CASH, CHECK# RECEIVEDBY.