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HomeMy WebLinkAboutUtility Company ApprovalWATER SEWER g METER SZ. COMM �- RES M/F IRR DD t7� SECURITY DEP SERVICE FEE SAME DAY FEE _ OVERTIME FEE �QD METERINSTAL 73 _ UD CFC/WATER FPUA CFC .(�©. CFC/SEWER GUAR. REV. LATERAL LO?D, TOTAL J, ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION NAME ACCT. # /S5vo? `" Ll SERVICE ADDRESS �30?3 SUBDIVISION ___re-- r 09 R LOT C:� 09 BLOCK BILLING ADDRESS66 EMAIL ADDRESS: - p n J PHONE # 90 - 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 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 THE UTH.iTY SERVICE APPLIED FOR ON THE DAY THE WATER METER OR OTHER UTnM 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 OFFICE USE ONLY z� DATE RECEIVED CASH CHECK#�70-4 RECEIVED BY -X-73-71