HomeMy WebLinkAboutNEW CUSTOMER APPLICATIONWATE R
SEWER
g METER SZ.
L_ ur c-_mp.
A".4
COMM
RES
M/F
IRR
$ SECURITY DEP
i
SERVICE FEE
SAME DAY FEE
f 2 OVERTIME FEE
213 00 METER INSTAL
31773 _ UD CFC/WATER
FPUA CFC
c� •�Q: CFC/SEWER
GUAR. REV.
/�
LATERAL
$ V009. D- TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
1NAME a -/Kr //U���S�' - —
41-471,&T R__
ACCT. # 16�5-VQ -- `'�V.3
SERVICE
' '53o r?
349'
SUBDIVISION_ ,7e LOT 625� BLOCK
IL
BILLING ADDRESS 'f' �� � [J14 j��y%�
EMAIL ADDRESS:
p /�
PHONE # 90 — D `7 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.
APPLICANT AGREES THAT APPLICANT WILL BEGIN PAYING BASE FACILITY CHARGES FOR TBE UTILITY SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTII.ITY SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WSEN 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