HomeMy WebLinkAboutUtility Company ApprovalATEROMM
SEWER
✓ RES
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5 METER SZ.
M/F
1RR
$ U
SECURITY DEP
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SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
NAME D/ 4
ACCT. # / Uy0 ---- � q y
SERVICE
A),'
Fort Pierce, FL 34945
SUBDIVISIONL�OD&7 � LOT 33 BLOCK
BILLING
EMAILAD%%DRESS: �QMPARRIN00-DRHORTON.COM
PHONE #> Q )) C / 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 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.
E] j''� APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILI"I'Y CHARGES FOR THE UTILITY SERVICE
` I APPL1(ED FOR ON THE DAY THE WATER METER OR OTHER UTILITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF'WE EN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE 77;f l- 27-4/7e SOCIAL SEC/FED ID —
NAME OF SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY