HomeMy WebLinkAboutUtility Company ApprovalATER-
MM
SEWER
RES
METER SZ.
M/F
IRR
$ �r 0
7 SECURITY DEP
SERVICE FEE'
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ l y TOTAL
ST LUCIE COUNTY WATER &.SEWER DISTRICT (SLCU)r
NEW CUSTOMER APPLICATION
�0- Anm/d
ACCT. # / U lJ VU '— /a'16
SERVICE
/6 /2
,AL
.Fort Pierce, FL.34945
'D67 � �o
SUBDIVISION ..LOT BLACK
BILLING ADDRESS 6 �T�.� C.LG09
EMAIL -ADDRESS:. DMPARRIIN00—DRHORTON.COM
PHONE �(CR (cJJ- !' ✓ ;� 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.
El"APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING RASE FACILITY CHARGES FOR THE-UTILTff SERVICE
- APPLIED .FOR ON, THE DAY. THE WATER METER OR ::OTEER UTII,TI'Y SERVICE CONNECTION IS INSTAIJ ED AT
APPLICANT'S PROPERTY,. REGARDLESS OF WREN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE:
CUSTOMER SIGNATURE 6sL2 a4izl." SOCIAL SEC/FED ID "
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE -RECEIVED CASH CHECK# RECEIVED BY