HomeMy WebLinkAboutUtility Company ApprovalWATER COMM
SEWER RES
METER SZ. M/F
IRR
� D?I
$ SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$ CADS
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # 166-zl o? 33 1 Y'
SERVICE
SUBDIVISIO
BILLING
3VI?
LOT BLOCK
EMAIL ADDRESS: ]
PHONE #`//O5 - F"cl�MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to renderwater 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 FACILITY CHARGES FOR THE 1111MY SERVICE
APPLIED FOR ON TIC DAY THE WATER METER OR OTHER U XIY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED IDq to ol to
NAME OF SPOUSE SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY