HomeMy WebLinkAboutUtility Company ApprovalWATER
1L SEWER
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ST LUCIE COUNTY WATER& SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME Arm U&7-
ACCT. # . [a, cJ., .Y' fqC --
SERVICE ADDRESS .... 33
SUBDIVISION Y%� LOT BLOCK `
BILLING
6U_1
EMAILADDRESS: - r
PHONE # qO D p �'n 7 T MOVE IN/CLOSING DATE
This application hereby requests and authorizes the Utility to render water and/orsewage 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 FAC ITY CHARGES FOR THE UTILITY SERVICE
U APPLIED FOR- ON THE DAY THE WATER METER OR OTHER UI HM SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTMIZING THE METER AND/OR SERVICE.
SOCIAL SEC/FED ID
NAME OF SPOUSE'` SPOUSE SOCIAL 3.
OFFICE USE ONLY ff
DATE RECEIVED CASH CHECK0�!
RECEIVED BY
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