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WATER COMM
SEWER --7"'RES
METER SZ. M/F
IRR
$ SECURITY DEP
SERVICE FEE
'i
SAME DAY FEE
OVERTIME FEE
'3r..DQ METER INSTAL
CFC/WATER
FPUA CFC
CFC/SEWER
GUAR. REV.
LATERAL
TOTAL
ST LUCIE COUNTY WATER & SEWER DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
ACCT. # 15-5-7";? I
SERVICE ADDRESS
SUBDIVISION
BILLING ADDRESS
EMAIL ADDRESS:
LOT
PHONE #` 05' ' p 3 VMOVE IN/CLOSING DATE
BLOCK
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This application hereby requests and authorizes the Utility to renderwater 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 UIUM SERVICE
APPLIED FOR ON THE DAY THE WATER METER OR OTHER urH= SERVICE CONNECTION IS INSTALLED AT
APPLICANT'S PROPERTY, REGARDLESS OF WHEN APPLICANT STARTS UTILIZING THE METER AND/OR SERVICE.
CUSTOMER SIGNATURE SOCIAL SEC/FED 1D
NAME OF SPOUSE
SPOUSE SOCIAL
OFFICE USE ONLY
DATE RECEIVED CASH CHECK # RECEIVED BY