HomeMy WebLinkAboutWATER & SEWER CUSTOMER APPLICATIONWATER
COMM
�C SEWER �-- RES
g METER SZ. M/F
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
IV3 QQ METER INSTAL
3/)73- UD CFC/WATER
FPUA CFC
CFC/SEWER
p�CILIGUAR. REV.
LATERAL
$ 3 l TOTAL
NAME—
ACCT. #_
SERVICE
ST LUCIE COUNTY WATER & SEWER -DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
I j .
lda,mr
ISYVQ —.
�3t)
SUBDIVISION i�%e✓
BILLING ADD
EMAIL ADDRESS:
.4006 6UA�
r
LOT BLOCK
&W&e2e, . rl
PHONE # (•lJ 0 7 T 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 orfuture 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 RON NEGOTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR THE UTHM SERVICE
Q� APPLIED FOR ON THE DAY THE' WATER METER OR OTHER U H-ITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE
NAME OF SPOUSE
SOCIAL SEC/FED ID
SPOUSE SOCIAL
f OFFICE USE ONLY %� ,�%
DATE RECEIVED rJ ` l CASH CHECK # RECEIVED BY -04w x, -
WATER
�C SEWER
METER SZ.
_Comm
RES NAME
M/F ACCT.
IRR
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
00 METER INSTAL
T� 3173. 0_0 CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
$1
�^ TOTAL
ST LUCIE COUNTY WATER & SEWER -DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
8yt/9921
r
SERVICE ADDRESS 4 ,
J '
-SUBDIVISION ! YTP✓ LOT BLOCK
BILLING
ADDRESS
EMAIL ADDRESS: p n
PHONE fig O7 T _ _ MOVE IN/CLOSING DATE
This application hereby requests' and authorizes the Utility to render water sewage disposal
services to the premises described above In accordance with the Utilities present orfuture, rates, rules and
regulations, which by reference are made apart 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 TRAT APPLICANT WILL BEGIN- PAMG BASE FACILITY CHARGES FOR TM UTRM SIERVICE
APPEND FOR ON THE DAY THE'' WATER WTER OR OTEER UnMY .SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTIL Z,IIITG THE METER AND/OR SERVICE.
NAME OF SPOUSE `---�� SPOUSE SOCIAL
OFFICE USE ONLY ,Q
U�
DATE RECEIVED r �� ` CASH _._� CHECK # RECEIVED BY