HomeMy WebLinkAboutUtility Company ApprovalWATER :COMM
SEWER $L RES.
METER SZ., ..M/F
IRR
$dD Ov
SECURITY DER`
SERVICE FEE
SAME "DAYFEE
OVERTIME FEE
METEKINSTAL
tFC/WATER
FPuA-CfC'
1 o;. CFt/$EWER
GUAR..REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER &SEWERDISTRICTf-SLCU)
NEW cbsTOMERAPPLICATION
V! _7 LOT OLOIC
EMAIL -ADDRESS:
PHONE-.,,#;. MOVE IN/CLOSINGZATE
ThIs-spIJIIcatibfi,herdbv-req eiMaqd-authodze& e.: [Itty-to-renderw.ater-anq/6rttWagodispqs.-aI
p k ..0 th V.t
services-tothe prpmlses.-describ6.d.'a-bQve-,Iii 6ccoirdancemith the Utilities preserit.-drfiftre rates, rules and.
regulAtlonsj,whkh byreference are made..a part ofthis cohtr.a-pti,Applicent-agrA*s,td.pay iltillty, pr6ftiptiVfor
tuch:servicesin, accordance wlth`tho -established rules androgtilations.
CLlSTOMEffS--DEPQSITSARE-NpN NEGOTIAIiLE,011 TRANSFERABLE,
APPLICANT AGREES THAT'APPJJCANT' WILL BEGIN PAYING-'BASEFACn,= CJ�URGE
S'IFOR-'=1113 IM—SERVICEAPPLM FOR ON DAY TM WATER 3M= IOR OTE MR UTHMSERVICE' CONNIECHON IS' INSTALLED AT
I All ATPLICA"S-T!ft��-L REGARDESS' I 0F,'vvIIEN APPLICANT, ST"TS'UTn"JKG VIE, MTM AND/OR SERVICCE:.
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NAMEOF'SPOUSE SPOUSE SOCIAL:
OFFICE USE, ONLY -
DATE RECEIVED CASH CHECK A- RECEIVEDBY