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HomeMy WebLinkAboutUTILITY CUSTOMER APPLICATIONV WATER SEWER METER SZ. COMM 7"RES M/F /� IRR $ SECURITY DEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTAL CFC/WATER FPUA CFC CFC/SEWER GUAR. REV LATERAL C $ D ©© TOTAL [D U ST LUCIE COUNTY WATER-c SEWER DISTRICT (SLCU) NEW CUSTOMER APPLICATION ACCT. # 155z1CQ - 33 a 3 SERVICE M01 SUBDIVISIO BILLING UiUO Ryt- r J( 3 w--) LOT --&c�2— BLOCK_ EMAILADDRESS: �/�, L / PHONE #`7A• - 73 T MOVE IN/CLOSING DATE to 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 UFHXIY SERVICE APPLIED FOR ON THE DAY THE WATER METER OR OTHER U H-XIY 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 2 OFFICE USE ONLY �J �j ,'� ---- DATE �Q RECEIVED �Q • 3O • �l CASH CHECK # F 07 RECEIVED BY �G'�GV