HomeMy WebLinkAboutUtility Company ApprovalU cl'-
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ATER
SEWER
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METER SZ.
M/F
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SECURITY DEA
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ I i TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NAME J) P—
NEW CUSTOMER APPLICATION
0-7-0 Av
ACCT. # 99 V8 -- 1/9 7
SERVICE ADDRESS
Fort Pierce, FL 34945
SUBDIVfS10NL�=`�"�'�D� LOT ` BLOCK
BILLING
.i /,C- /yc
EMAIL ADDRESS: 1DMPARRIN00-DRHORTOWCOM
PRONE #tl � ( � / 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 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.
-APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACEUTY CHARGES FOR THE UTILITY SERVICE -
APPLIED FOR ON TIIL+ DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTHAMG THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIALSEC/FED ID
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY