HomeMy WebLinkAboutNEW CUSTOMER APPLICATION UTILITIESWATER
SEWER
METER SZ.
T, ErLi—tULW J1 -j -VA
-
COMM
- RES
M/F
IRR
$ DO Rq 0" SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
,31 ?3 _ 00. CFC/WATER
FPUA CFC
Qd, CFC/SEWER
Z4
GUAR. REV.
�*}l LATERAL
$ �`7g• �(;/ TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
nnme -!y!l A-Mu,Y/<7'T i�
v
ACCT. # 1 - 17b
SUBDIVISION LOT 07-3 BLOCK 3
BILLING ADDRESS I D06 6uq
EMAIL ADDRESS:
PHONE #=/05— O �� 7` I MOVE IN/CLOSING DATE
3Q9,3
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 FACILITY CHARGES FOR THE UTHM .SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS. OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED ID
NAME.OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY