HomeMy WebLinkAboutUtility Company ApprovalWATER
C
.�
i 4,11., Ntr 11- �.
COMM
K SEWER K RES
!797- METER SZ. M/F
IRR
r Ji $ d SECURITY DEP
/19-
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
`TJ � 0 METER INSTAL
,39'73 - a 0 CFC/WATER
FPUA CFC
:'3t Q L) CFC/SEWER
GUAR. REV.
LATERAL
$ 60 TOTAL
NAM
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
/ SUBDIVISION17�� LOT 3eg BLOCK
BILLING ADDRESS c.�I Q
EMAIL ADDRESS:
PHONE # 9US'� 43 3 "� T MOVE IN/CLOSING DATE
3P-S13
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.
i APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER U1MJTY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING TEE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
OFFICE USE ONLY may_ Q ��J /�
DATE RECEIVED �' I CASH CHECK# � `�5�) RECEIVED BY A /J(JA4A
?71-19d-t