HomeMy WebLinkAboutUtility Company Approval4 , L :c
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ST LU.CIE COUNTY WATER & SEWER -DISTRICT (SLCU)
. NEW .CUSTOMER APPLICATION
NAME // a t -A/
SERVICE ADDRESS
Fort Pierce, FL 34945
SUBDIV1SlON
/�.... .LOT BLOCK.....
.BILLING: ADDRESSNV C:w/��- �VC IJ6
EMAILADDRESS' DMPARRINO _DRHORTON.COM .
PHONE 4C5Q V3_ ! ! / 2 MOVE INICLOSING DATE
This application herebyrequests 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 of this contract. Applicant agrees.to pay Utility pnomptlyfor
such services In accordance with the established rules and regulatlon&
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGRFDS THAT APPLICANT W�L BBEG]N PAIING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLM FOR ON THE DAY THE : WATER. METER OR .OTHER UTi "V SERVICE CONI�CTION IS Il�TSTALLTD AT
APPLICANT'S PROPERTY, REGARDLESS Op VjIMN APPLICANT STARTS UTH IMG_THE lvrrTre.R AND/OR SERVICE.
CUSTOMER SIGNATURE T �lsd> Otrite . SOCIAL SECJFED ID
NAME -OF SPOUSE SPOUSE SOCIAL
OFFICE USE ONLY -
DATE -RECEIVED 3' :-1k CASH C"k'# RECEIVED BY I (�